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More options for the treatment of ARMD
Medical Abstracts
265
These findings suggest that secondgeneration FDP has the diagnostic ability to detect abnormalities in those with early to moderate glaucomatous visual field damage. Evidence also suggests that FDP may be more sensitive to early glaucomatous loss. In this study, FDP showed high sensitivity and specificity when compared with SAP. The question of whether FDP can detect glaucomatous visual field loss sooner than SAP cannot be answered by this study alone. Researchers suggest longitudinal studies monitoring early glaucomatous visual field progression would better address this issue. Jason Price, O.D. doi:10.1016/j.optm.2007.04.090
More options for the treatment of ARMD Augustin AJ, Puls S, Offerman I. Triple therapy for choroidal neovascularization due to age-related macular degeneration: verteporfin PDT, bevacizumab, and dexamethasone. Retina 2007;27(2):133-40. Choroidal neovascularization (CNV) resulting from age-related macular de-
generation (ARMD) often is visually devastating. Over the last few years, several treatments have been utilized to reduce the associated ocular morbidity of CNV. Photodynamic therapy (PDT) was seen as a significant advancement in the treatment of CNV; however, it was not without drawbacks such as cost, need for repeated treatments, side effects, and patient inconvenience. Intravitreal injections of corticosteroids (triamcinolone) have been combined with PDT in the treatment of CNV with modest success. With this in mind, the authors set out to determine if adding the vascular endothelial growth factor (VEGF) inhibitor bevacizumab (Avastin; Genentech, Inc., San Francisco, California) to the treatment regimen would prove beneficial. In addition, the corticosteroid dexamethasone was used instead of triamcinolone for its reduced side effects. One hundred four patients with all types of CNV secondary to ARMD were included. Each patient underwent the “triple procedure” of PDT, dexamethasone, and Avastin injection. Eighteen patients had an additional injection of Avastin, and 5 patients had the “triple therapy” regimen repeated because of the reactivity of the CNV.
The overall mean visual acuity improved by 1.8 lines. A total of 39.4% of the participants improved 3 lines or more, whereas only 3.8% decreased 3 lines or more. Additionally, no severe adverse events were reported, and no increases in intraocular pressures were observed after a 40-week mean follow-up period. The results of this study are similar to the results reported on monthly monotherapy via anti-VEGF intravitreal injections. However, a one-time “triple therapy” procedure could prove to be desirable if it reduces cost, increases patient convenience, and decreases potential side effects. Although the authors attest that the particular treatment regimens in this study may not be optimal, no currently available single treatment regimen addresses the multifactorial pathogenesis of CNV. In the context of treating ARMD, these are exciting times. Patients as well as practitioners now have more options, putting one of the world’s leading causes of blindness on notice. Barry J. Frauens, O.D. doi:10.1016/j.optm.2007.04.091
265
These findings suggest that secondgeneration FDP has the diagnostic ability to detect abnormalities in those with early to moderate glaucomatous visual field damage. Evidence also suggests that FDP may be more sensitive to early glaucomatous loss. In this study, FDP showed high sensitivity and specificity when compared with SAP. The question of whether FDP can detect glaucomatous visual field loss sooner than SAP cannot be answered by this study alone. Researchers suggest longitudinal studies monitoring early glaucomatous visual field progression would better address this issue. Jason Price, O.D. doi:10.1016/j.optm.2007.04.090
More options for the treatment of ARMD Augustin AJ, Puls S, Offerman I. Triple therapy for choroidal neovascularization due to age-related macular degeneration: verteporfin PDT, bevacizumab, and dexamethasone. Retina 2007;27(2):133-40. Choroidal neovascularization (CNV) resulting from age-related macular de-
generation (ARMD) often is visually devastating. Over the last few years, several treatments have been utilized to reduce the associated ocular morbidity of CNV. Photodynamic therapy (PDT) was seen as a significant advancement in the treatment of CNV; however, it was not without drawbacks such as cost, need for repeated treatments, side effects, and patient inconvenience. Intravitreal injections of corticosteroids (triamcinolone) have been combined with PDT in the treatment of CNV with modest success. With this in mind, the authors set out to determine if adding the vascular endothelial growth factor (VEGF) inhibitor bevacizumab (Avastin; Genentech, Inc., San Francisco, California) to the treatment regimen would prove beneficial. In addition, the corticosteroid dexamethasone was used instead of triamcinolone for its reduced side effects. One hundred four patients with all types of CNV secondary to ARMD were included. Each patient underwent the “triple procedure” of PDT, dexamethasone, and Avastin injection. Eighteen patients had an additional injection of Avastin, and 5 patients had the “triple therapy” regimen repeated because of the reactivity of the CNV.
The overall mean visual acuity improved by 1.8 lines. A total of 39.4% of the participants improved 3 lines or more, whereas only 3.8% decreased 3 lines or more. Additionally, no severe adverse events were reported, and no increases in intraocular pressures were observed after a 40-week mean follow-up period. The results of this study are similar to the results reported on monthly monotherapy via anti-VEGF intravitreal injections. However, a one-time “triple therapy” procedure could prove to be desirable if it reduces cost, increases patient convenience, and decreases potential side effects. Although the authors attest that the particular treatment regimens in this study may not be optimal, no currently available single treatment regimen addresses the multifactorial pathogenesis of CNV. In the context of treating ARMD, these are exciting times. Patients as well as practitioners now have more options, putting one of the world’s leading causes of blindness on notice. Barry J. Frauens, O.D. doi:10.1016/j.optm.2007.04.091