Low fluence rate photodynamic therapy combined with intravitreal bevacizumab for neovascular age-related macular degeneration
Low fluence rate photodynamic therapy combined with intravitreal bevacizumab for neovascular age-related macular degeneration
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DOI：
10.1136/bjo.2009.159343
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发表时间：
2010-02-01
影响因子：
4.1
通讯作者：
Semeraro, Francesco
中科院分区：
文献类型：
--
作者：
Costagliola, Ciro;Romano, Mario R.;Semeraro, Francesco
目的观察玻璃体内注射贝伐单抗（IVB）与IVB联合低通量光动力疗法（PDT）治疗老年性黄斑变性（AMD）的疗效和安全性，并验证联合治疗对视力、病变大小、形态及治疗率的协同作用。或继发于AMD的主要典型的中心凹下脉络膜新生血管形成。患者被随机分配到第1组（IVB注射）和第2组（IVB加低通量PDT）。在第2组中，以低能量密度（300 mW/cm（2），83 s，25 J/cm（2））输送含维替泊芬的PDT。随访时间分别为1、3、6、9和12个月。结果无复发眼平均接受2.8次（第1组）和1.4次（第2组）IVB注射，而复发眼平均接受3.2次（第1组）和2.2次（第2组）IVB注射。两组之间的再注射率差异具有统计学显著性（p = 0.03，ANOVA检验）。结论IVB联合低通量PDT治疗经典型或以经典型为主的新生血管性AMD具有协同作用，可显著降低IVB再注射率。
Aims To report the efficacy and safety of intravitreal bevacizumab (IVB) alone versus IVB plus low-fluence photodynamic therapy (PDT) in age-related macular degeneration (AMD) patients and to verify the occurrence of a synergistic effect of the combined approach on visual acuity, size and morphology of lesion, as well as on the treatment rate.Method Prospective comparative interventional study on 85 patients with treatment-naive classic, or predominantly classic, subfoveal choroidal neovascularisation secondary to AMD. Patients were randomly assigned to group 1 ( IVB injections) and group 2 ( IVB plus low fluence PDT). In group 2, the PDT with verteporfin was delivered with a low fluence rate ( 300 mW/cm(2) for 83 s, 25 J/cm(2)). The follow-up was scheduled at 1, 3, 6, 9 and 12 months.Results The eye without recurrence received a mean of 2.8 ( group 1) versus 1.4 ( group 2) IVB injections, whereas the eyes with recurrence received a mean of 3.2 ( group 1) versus 2.2 ( group 2) IVB injections. The difference in reinjection rate between the two groups was statistically significant (p = 0.03, ANOVA test). Visual acuity improvement was not statistically significant between the two groups (p - 0.31).Conclusion The combination of IVB with low fluence PDT for the treatment of classic or predominantly classic neovascular AMD works in a synergistic fashion with a significant reduction in IVB reinjections rate.