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Klin Monbl Augenheilkd 2008; 225(7): 653-659
DOI: 10.1055/s-2008-1027455
Klinische Studie

© Georg Thieme Verlag KG Stuttgart · New York

Photodynamische Therapie kombiniert mit intravitrealer Injektion von Bevacizumab zur Behandlung okkulter und klassischer choroidaler Neovaskularisationen bei AMD

Photodynamic Therapy with Verteporfin Combined with Intravitreal Injection of Bevacizumab for Occult and Classic CNV in AMDM. Maier1 , K. Haas1 , N. Feucht1 , B. Fiore1 , C. Winkler von Mohrenfels1 , A. Clos1 , C. Lohmann1
  • 1Augenklinik, Klinikum rechts der Isar der TU München
Further Information

Publication History

Eingegangen: 14.11.2007

Angenommen: 3.3.2008

Publication Date:
18 July 2008 (online)

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Zusammenfassung

Hintergrund: Besonders okkulte choroidale Neovaskularisationen (CNV) mit Pigmentepithelabhebung (PED) zeigen nach Standard-PDT oft eine Vergrößerung der PED oder einen RPE-Riss. Untersucht wird der Effekt einer Kombination von photodynamischer Therapie (PDT) und intravitrealer Behandlung mit Bevacizumab bei okkulter und klassischer choroidaler Neovaskularisation (CNV) bei AMD. Methoden: In einer Pilotstudie wurden 23 Patienten mit okkulter oder klassischer CNV bei AMD mit intravitrealer Injektion von Bevacizumab (1,25 mg) 12 bis 24 Stunden nach Standard-PDT behandelt. Vor, 1, 3 und 6 Monate nach Behandlung wurden Sehschärfe und mit dem OCT die Netzhautdicke untersucht. Ergebnisse: Die mittlere Sehschärfe verbesserte sich im Vergleich zur Ausgangssehschärfe signifikant. (Visus vor Behandlung = 0,16, nach 1 Monat 0,26, nach 3 Monaten 0,25 und 0,25 nach 6 Monaten). Wir fanden keinen RPE-Riss. Die OCT-Untersuchung 1, 3 and 6 Monate nach Kombinationstherapie zeigte eine Reduktion der Netzhautdicke. Schlussfolgerung: Eine photodynamische Therapie kombiniert mit intravitrealer Applikation von Bevacizumab scheint aufgrund des Anti-VEGF- und des antientzündlichen Effektes von Bevacizumab wirksamer zu sein als eine PDT-Monotherapie. Unsere Kurzzeitergebnisse sind vielversprechend. Weitere Untersuchungen sind nötig, um den Langzeiteffekt der Kombinationstherapie von PDT und intravitrealer Anti-VEGF-Therapie zu überprüfen.

Abstract

Purpose: The aim of this study is to discuss the effect and outcome of a combined photodynamic therapy and intravitreal injection of bevacizumab (1.25 mg) in occult and classic choroidal neovascularisation (CNV) due to AMD. Especially cases of occult CNV with pigment epithelium detachment (PED) are not likely to respond positively to standard photodynamic therapy, often ending up in PED enlargement or tearing of the RPE. Methods: In a pilot study involving 23 patients, intravitreal injections of bevacizumab were administered within 12 to 24 hours after standard PDT to reduce the post-PDT increase of proangiogenic and inflammatory factors. Before and at 1, 3 and 6 month after treatment visual acuity and OCT examinations (retinal thickness) were performed. Results: Mean visual acuity was significantly improved compared to baseline. (VA baseline 20 / 125, after 1 month 20 / 80, after 3 months 20 / 80, and 20 / 80 after 6 months) and an enlargement of the PED in occult CNV was prevented. We found no RPE rip. OCT findings in patients with occult and classic choroidal neovascularisation 1, 3 and 6 months after combination therapy showed a reduced retinal thickness compared to baseline. Conclusions: Photodynamic therapy combined with injection of intravitreal bevacizumab tends to be more effective compared to PDT monotherapy by reducing the post-PDT increase of vascular growth and inflammatory factors. Our short-term results are very promising. Further studies are necessary to show the long-term effect of PDT and anti-VEGF combination therapy.

Schlüsselwörter

Retina - Glaskörper - Chorioidea

Key words

retina - vitreous - choroid

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Dr. med. Mathias Martin Maier

Klinik und Poliklinik für Augenheilkunde rechts der Isar der Technischen Universität München

Ismaningerstr. 22

81675 Munich

Phone: ++ 49/89/41 40 23 40

Fax: ++ 49/89/41 40 48 58

Email: M.Maier@lrz.tum.de