Bakri Sophie J, Couch Steven M, McCannel Colin A, Edwards Albert O
Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota 55905, USA.
Retina. 2009 May;29(5):573-8. doi: 10.1097/IAE.0b013e3181a46a8a.
To report the results of same-day triple therapy with reduced fluence photodynamic therapy, intravitreal dexamethasone, and bevacizumab in patients with neovascular age-related macular degeneration.
Retrospective case series. Records of patients who received same-day triple therapy with reduced fluence photodynamic therapy (25 J/cm), intravitreal dexamethasone (200 microg), and intravitreal bevacizumab (1.25 mg) were reviewed. All patients had neovascular subfoveal age-related macular degeneration with at least 1 year of follow-up. Snellen visual acuity (VA), central macular thickness on optical coherence tomography, intraocular pressure, and endophthalmitis occurrence were recorded.
The 31 patients were observed for a mean of 13.7 months. In all patients, mean baseline VA was 20/80 and vision at final follow-up was 20/60 (P = 0.69). In patients who received previous treatment for exudative age-related macular degeneration (n = 18), mean baseline VA was 20/100 and vision at final follow-up (mean, 13.7 months) was 20/100 (P = 0.31). In treatment-naïve patients (n = 13), mean baseline VA was 20/60 and vision at final follow-up (mean, 13.5 months) was 20/40 (P = 0.31). In all patients, mean central macular thickness was 293 mum at baseline and 245 mum at final follow-up (P = 0.053). In previously treated patients (n = 18), mean central macular thickness was 325 mum at baseline and 265 mum at final follow-up (P = 0.10). In treatment-naïve patients, mean central macular thickness was 249 mum at baseline (n = 13) and 218 mum at final follow-up (P = 0.34). Previously treated patients required more antivascular endothelial growth factor injections (mean = 3.6) than treatment-naïve patients (mean = 0.8), but the mean number of repeat triple therapy treatments was 0.3 in both groups. Changes in intraocular pressure and endophthalmitis were not observed during follow-up.
Same-day triple therapy maintained VA and decreased macular thickness in patients with and without previous antivascular endothelial growth factor therapy. Triple therapy may reduce the number of antivascular endothelial growth factor injections in some patients and stabilize vision in some patients not responding to antivascular endothelial growth factor therapy.
报告在新生血管性年龄相关性黄斑变性患者中，采用低能量光动力疗法、玻璃体内注射地塞米松和贝伐单抗进行同日三联疗法的结果。
回顾性病例系列研究。对接受低能量光动力疗法（25 J/cm²）、玻璃体内注射地塞米松（200微克）和玻璃体内注射贝伐单抗（1.25毫克）同日三联疗法的患者记录进行回顾。所有患者均患有黄斑中心凹下新生血管性年龄相关性黄斑变性，且至少随访1年。记录Snellen视力（VA）、光学相干断层扫描测量的中心黄斑厚度、眼压及眼内炎的发生情况。
31例患者平均观察13.7个月。所有患者的平均基线视力为20/80，末次随访时视力为20/60（P = 0.69）。既往接受过渗出性年龄相关性黄斑变性治疗的患者（n = 18），平均基线视力为20/100，末次随访（平均13.7个月）时视力为20/100（P = 0.31）。初治患者（n = 13），平均基线视力为20/60，末次随访（平均13.5个月）时视力为20/40（P = 0.31）。所有患者的平均中心黄斑厚度基线时为293微米，末次随访时为245微米（P = 0.053）。既往接受过治疗的患者（n = 18），平均中心黄斑厚度基线时为325微米，末次随访时为265微米（P = 0.10）。初治患者平均中心黄斑厚度基线时为249微米（n = 13），末次随访时为218微米（P = 0.34）。既往接受过治疗的患者比初治患者需要更多的抗血管内皮生长因子注射（平均 = 3.6次对比平均 = 0.8次），但两组重复三联疗法治疗的平均次数均为0.3次。随访期间未观察到眼压变化及眼内炎发生。
同日三联疗法在既往接受过和未接受过抗血管内皮生长因子治疗的患者中均能维持视力并降低黄斑厚度。三联疗法可能会减少部分患者抗血管内皮生长因子的注射次数，并使一些对抗血管内皮生长因子治疗无反应的患者视力稳定。
