Triple Therapy for Choroidal Neovascularization Due to Age-Related Macular Degeneration

In Brief Purpose: To evaluate the efficacy and safety of triple therapy with verteporfin photodynamic therapy (PDT), dexamethasone, and bevacizumab in choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD). Methods: This prospective, noncomparative, interventional case series included 104 patients. Verteporfin PDT was administered with a reduced light dose (42 J/cm2, accomplished by light delivery time of 70 seconds). Approximately 16 hours after PDT, dexamethasone (800 μg) and bevacizumab (1.5 mg) were injected intravitreally. Patients attended follow-up visits every 6 weeks, undergoing visual acuity and intraocular pressure measurement, slit-lamp and ophthalmoscopic examination, and optical coherence tomography (OCT). Fluorescein angiography was performed every 3 months or earlier if OCT showed significant edema. Results: All 104 patients received one triple therapy cycle (5 patients received a second triple treatment due to remaining CNV activity). The triple therapy was complemented in 18 patients (17.3%) by an additional intravitreal injection of bevacizumab. The mean follow-up period was 40 weeks (range, 22–60 weeks). Mean increase in visual acuity was 1.8 lines (P < 0.01). Mean decrease in retinal thickness was 182 μm (P < 0.01). No serious adverse events have been observed. Conclusion: In most patients with CNV due to AMD, triple therapy results in significant and sustained visual acuity improvement after only one cycle of treatment. In addition, the therapy offers a good safety profile, potentially lower cost compared with therapies that must be administered more frequently, and convenience for patients. Triple therapy with verteporfin photodynamic therapy, bevacizumab, and dexamethasone results in a significant increase of mean VA after one cycle of treatment in most of the patients with choroidal neovascularization due to age-related macular degeneration. Only 5 patients needed retreatment with triple therapy due to recurrency of CNV activity.