Abstract

FR.13.07

Combined therapy – long-term results. Choroidal Neovascularizations in AMD, diabetic retinopathies and retinal venous occlusions

Koch F.
Universitäts-Augenklinik Frankfurt

The combination of PDT, a 0.4ml core vitrectomy, and an intavitreal injection of bevacizumab and dexamethasone (multiple therapy) for CNVs in ARMD indicated sustainable and effective results in prospective case series. To date a similar outcome without PDT and/or core vitrectomy is unknown. Ten months after multiple therapy a mean gain of 1.8 lines was noticed in 104 patients with a re-treatment rate of 5 patients because of persisting CNV activity (Retina 27: 133 – 140, 2007). 52 eyes in our study proved a mean gain of 1.65 lines after 14 months with one additional course of multiple therapy after 9 months in 13/52 eyes (25%). In comparison to the pretreatment levels none of the patients lost lines (Retina Subspecialty Meeting 2006, Masters Meeting 2007) while a membrane re-occurence was exclusively detected in one of the 10 re-treated patients (4 weeks after cataract surgery).
The concept of combined pharmacotherapy (corePPV, bevacizumab, dexamethasone or triamcinolone) is also benefitial for other vitreoretinal diseases. Six months after cPPV with application of bevacizumab and dexamethasone or triamcinolone in 10 patients with macular edema due to venous occlusion and 10 patients mit diabetic macular edema a sustained decrease in macular thickness (OCT) and rise in visual acuity was observed. Fifteen patients with mild vitreal bleeding experienced visual acuity increase six months after a core ppV with removal of the bleeding and intravitreal bevacizumab and dexamethasone injection. No patient presented with a bleeding recurrence.
In our opinion combined therapy significantly reduces the frequency of diagnostic and therapeutic actions. The development of visual acuity is comparable to the one after mono- or dualtherapies, which warrants significantly more re-treatments. As combined therapy addresses several aspects, it leads to earlier and sustained stabilization for our patient´s vision and might on the other hand be more cost-effective for the federal health system.

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