Evaluation of Photodynamic Therapy-Combined Intravitreal Bevacizumab in Age Related Macular Degeneration

Yıl 2024, Cilt: 9 Sayı: 1, 8 - 13, 15.04.2024

Emine Pangal , Abdullah Özkırış

https://doi.org/10.55694/jamer.1385738

Öz

Aim: It was aimed to compare treatment results of photodynamic therapy (PDT) and PDT-combined intravitreal bevacizumab injection (PDT+IVB) in patients with age-related macular degeneration (AMD).
Materials and Methods: 63 eyes of 55 patients with neovascular AMD were included. Group 1 consisted of 40 eyes of 35, Group 2 consisted of 23 eyes of 20 patients. Visual acuity (VA), intraocular pressure measurement and fundus examination were performed. Pattern Electroretinography P50 amplitude and edema map values (EMV) were measured with Heidelberg Retina Tomograph (HRTII).
Results: VA increased in 14 (35%), remained unchanged in 17 (42.5%), and decreased in 9 (22.5%) eyes in Group
1 (PDT). The PERG P50 amplitudes were compared with values of pre-treatment, and found to increased at 10.6%, 11.98%, and 8.46% and HRTII EMV were 5.86%, 4.88%, and 11.22% at 1st, 3rd, and 6th months, respectively. In Group 2 (PDT+IVB), VA improved in 9 (39.13%), remained unchanged in 8 (34.78%), and decreased in 6 (34.78%) eyes. PERG P50 amplitudes were reduced to 10.15%, 5.8%, and 0.1% and HRTII EMV were reduced to 13.07%, 12.17%, and 14.87% at 1st, 3rd, and 6th months, respectively.
Conclusion: Verteporfin and PDT are effective and safe methods that preserve VA in subfoveal choroidal neovascular membranes due to neovascular AMD.

Anahtar Kelimeler

Age-related macular degeneration, photodynamic therapy, vascular endothelial growth factor, early diagnosis, intravitreal injection, bevacizumab

Yaşa Bağlı Makula Dejenerasyonunda Fotodinamik Tedavi ile Kombine İntravitreal Bevacizumabın Değerlendirilmesi

Öz

Amaç: Yaşa bağlı makula dejenerasyonu (AMD) olan hastalarda fotodinamik tedavi (PDT) ve PDT ile kombine intravitreal bevacizumab enjeksiyonu (PDT+IVB) tedavi sonuçlarının karşılaştırılması amaçlandı.
Gereç ve Yöntemler: Neovasküler YBMD’li 55 hastanın 63 gözü dahil edildi. Grup 1 35 hastanın 40 gözü, Grup 2, 20 hastanın 23 gözü içermekteydi. Görme keskinliği (VA), göz içi basıncı ölçümü ve göz dibi muayenesi yapıldı. Patern Elektroretinografi P50 genliği ve ödem haritası değerleri (EMV) Heidelberg Retina Tomografi (HRTII) ile ölçüldü.
Bulgular: Grup 1’de (PDT) 14 (%35) gözde VA arttı, 17 (%42.5)’sinde değişmedi, 9 (%22.5)’unda azaldı. PERG
P50 amplitüdleri tedavi öncesi değerlerle karşılaştırıldı ve 1., 3. ve 6. aylarda sırasıyla %10.6, %11.98 ve %8.46
artmış ve HRTII EMV %5.86, %4.88 ve %11.22 bulundu. Grup 2’de (PDT+IVB) 9 (%39.13)’unda VA düzeldi, 8 (%34.78)’inde değişmedi, 6 (%34.78)’sında azaldı. PERG P50 amplitüdleri 1., 3. ve 6. aylarda sırasıyla %10.15, %5.8 ve %0.1, HR-TII EMV %13.07, %12.17 ve %14.87 azaldı.
Sonuç: Verteporfin ve PDT, neovasküler AMD’ye bağlı subfoveal koroidal neovasküler membranlarda VA’yı koruyan etkili ve güvenli yöntemlerdir.

Anahtar Kelimeler

Yaşa bağlı makula dejenerasyonu, fotodinamik tedavi, vasküler endotelyal büyüme faktörü, erken tanı, intravitreal enjeksiyon, bevacizumab

Kaynakça

• Referans1 Thomas CJ, Mirza RG, Gill MK. Age-Related Macular Degeneration. Med Clin North Am. 2021;105:473-91.
• Referans2 Mitchell P, Liew G, Gopinath B, Wong TY. Age-related macular degeneration.Lancet. 2018; 392:1147-59.
• Referans3 Celik T. Recent advances on medical treatment of age-related macular degeneration. Medeniyet Med J 2016;31:128-33.
• Referans4 von der Emde L, Vaisband M, Hasenauer J, Bourauel L, Bermond K, Saßmannshausen M, Heintzmann R, Holz FG, Curcio CA, Sloan KR, Ach T. Histologic Cell Shape Descriptors for the Retinal Pigment Epithelium in Age-Related Macular Degeneration:A Comparison to Unaffected Eyes.Transl Vis Sci Technol 2022;11:19.
• Referans5 Mullins RF, Russell SR, Anderson DH, Hageman GS. Drusen associated with aging and age-related macular degeneration contain proteins common to extracellular deposits associated with atherosclerosis, elastosis, amyloidosis, and dense-deposit disease.Faseb J 2000;14:835-46. Referans6 Shams N, Ianchulev T. Role of vascular endothelial growth factor in ocular angiogenesis. Ophthalmol Clin N Am 2006;19:335-44.
• Referans7 Kabunga RR, Onyango J, Ruvuma S, Arunga S. Outcome of intravitreal Avastin® injections in patients with macular oedema in Uganda:a cohort study. Eye (Lond) 2022;36:45-50. Referans8 Puerta Cavanzo N, Riesmeijer SA, Holt-Kedde IL, Werker PMN, Piersma B, Olinga P, Bank RA. Verteporfin ameliorates fibrotic aspects of Dupuytren's disease nodular fibroblasts irrespective the activation state of the cells. Sci Rep 2022;12:13940.
• Referans9 Patel PN, Patel PA, Land MR, Bakerkhatib-Taha I, Ahmed H, Sheth V. Targeting the Complement Cascade for Treatment of Dry Age-Related Macular Degeneration. Biomedicines 2022;10:1884 Referans10 Ferris FL 3rd, Wilkinson CP, Bird A, Chakravarthy U, Chew E, Csaky K, Sadda SR; Beckman Initiative for Macular Research Classification Committee. Clinical classification of age-related macular degeneration. Ophthalmology 2013;120:844-51.
• Referans11 Wells JA, Murthy R, Chibber R, Nunn A, Molinatti PA, Kohner EM, Gregor ZJ. Levels of vascular endothelial growth factor are elevated in the vitreous of patients with subretinal neovascularisation.Br J Ophthalmol 1996;80:363-6. Referans12 Esser S, Wolburg K, Wolburg H, Breier G, Kurzchalia T, Risau W. Vascular endothelial growth factor induces endothelial fenestrations in vitro. J Cell Biol 1998;140:947-59.
• Referans13 Horner F, Lip PL, Mohammed BR, Fusi-Rubiano W, Gokhale E, Mushtaq B, Chavan R. Comparing Effectiveness of Three Different Anti-VEGF Treatment Regimens for Neovascular Age-Related Macular Degeneration:Two Years’ Real-World Clinical Outcomes.Clin Ophthalmol 2021;15:1703-13.
• Referans14 Murata M, Noda K, Kase S, Hase K, Wu D, Ando R, Ishida S. Placental growth factor stabilizes VEGF receptor-2 protein in retinal pigment epithelial cells by downregulating glycogen synthase kinase 3 activity.Biol Chem 2022;298(9):102378.
• Referans15 Spilsbury K, Garrett KL, Shen WY, Constable IJ, Rakoczy PE. Overexpression of vascular endothelial growth factor (VEGF) in the retinal pigment epithelium leads to the development of choroidal neovascularization.Am J Pathol 2000;157:135-44. Referans16 Rich RM, Rosenfeld PJ, Puliafito CA, Dubovy SR, Davis JL, Flynn HW Jr, Gonzalez S, Feuer WJ, Lin RC, Lalwani GA, Nguyen JK, Kumar G. Short-term safety and efficacy of intravitreal bevacizumab (avastin) for neovascular age-related macular degeneration.Retina 2006;26:495-511.
• Referans17 Inoue N, Kato A, Araki T, Kimura T, Kinoshita T, Okamoto F, Murakami T, Mitamura Y, Sakamoto T, Miki A, Takamura Y, Matsubara H, Tsujinaka H, Gomi F, Yasukawa T. Visual prognosis of submacular hemorrhage secondary to age-related macular degeneration: A retrospective multicenter survey. PLoS One 2022;17:e0271447.
• Referans218 Chawla R, Hasan N, Sundar D, Sharma A. Optical coherence tomography angiography-guided photodynamic therapy for extrafoveal choroidal neovascularization. Digit J Ophthalmol 2020;26:1-7.
• Referans19 Chen L, Wang B, Cui W, Fang S. Efficacy of ranibizumab combined with photodynamic therapy on wet age-related macular degeneration. Exp Ther Med 2020;19(6):3691-7. Referans20 Saviano S, Piermarocchi R, Leon PE, Mangogna A, Zanei A, Cavarzeran Sc F, Tognetto D. Combined therapy with bevacizumab and photodynamic therapy for myopic choroidal neovascularization: A one-year follow-up controlled study. Int J Ophthalmol. 2014; 18:7(2):335-9.
• Referans21 Potter MJ, Claudio CC, Szabo SM. A randomized trial of bevacizumab and reduced light dose photodynamic therapy in age-related macular degeneration: the VIA study. Br J Ophthalmol. 2010 Feb;94(2):174-9. doi: 10.1136/bjo.2008.155531.
• Referans22 Effect of lesion size, visual acuity, and lesion composition on visual acuity change with and without verteporfin therapy for choroidal neovascularisation secondary to age-related macular degeneration: TAP and VIP Report No. 1 Treatment of age-related macular degeneration with Photodynamic Therapy and Verteporfin in Photodynamic Therapy Study groups. Am J Ophthalmol 2003;136:407-18. Referans23 Brown DM, Kaiser PK, Michels M, Soubrane G, Heier JS, Kim RY, Sy JP, Schneider S; ANCHOR Study Group. Ranibizumab versus verteporfin for neovascular age-related macular degeneration. N Engl J Med 2006;355(14):1432-44.
• Referans24 Antoszyk AN, Tuomi L, Chung CY, Singh A; FOCUS Study Group. Ranibizumab combined with verteporfin photodynamic therapy in neovascular age-related macular degeneration (FOCUS): year 2 results. Am J Ophthalmol 2008;145(5):862-74.
• Referans25 Koh A, Lee WK, Chen LJ, Chen SJ, Hashad Y, Kim H, Lai TY, Pilz S, Ruamviboonsuk P, Tokaji E, Weisberger A, Lim TH. EVEREST study: efficacy and safety of verteporfin photodynamic therapy in combination with ranibizumab or alone versus ranibizumab monotherapy in patients with symptomatic macular polypoidal choroidal vasculopathy. Retina 2012;32(8):1453-64.
• Referans26 Lim TH, Lai TYY, Takahashi K, Wong TY, Chen LJ, Ruamviboonsuk P, Tan CS, Lee WK, Cheung CMG, Ngah NF, Patalauskaite R, Margaron P, Koh A; EVEREST II Study Group. Comparison of Ranibizumab With or Without Verteporfin Photodynamic Therapy for Polypoidal Choroidal Vasculopathy: The EVEREST II Randomized Clinical Trial. JAMA Ophthalmol 2020;138(9):935-42.