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Triple Regimen Safe and Effective for Choroidal Neovascularization Associated With Age-Related Macular Degeneration: Presented at ARVO

By Earl R. Nichols

FT. LAUDERDALE, F.L. -- May 2, 2006 -- A small study has found that patients who receive triple therapy with a combination of intravitreal triamcinolone, photodynamic therapy (PDT), and intravitreal Macugen (pegaptanib sodium) to treat their choroidal neovascularization (CNV) secondary to age-related macular degeneration achieve important improvements in visual acuity and in macular thickness.

The study involved 16 patients who were treated in a total of 22 eyes. Thirteen patients had received prior treatment of some form.

Patients received 10 mg of intravitreal triamcinolone initially, followed by standard verteporfin PDT, and finally, intravitreal injections of Macugen 0.3 mg, each given 2 weeks apart. Patients with evidence of progression of CNV on fluorescein angiography could be retreated with Macugen at 2-week intervals.

Analysis at 6.8 months of follow-up revealed an improvement in visual acuity of 0.7 lines on the Early Treatment of Diabetic Retinopathy Scale (EDTRS) for patients who had had prior treatment, but an improvement of 2.2 lines for those whose AMD was newly diagnosed and who had no prior therapy.

In all, 7.9% of those who had had prior therapy had an improvement in visual acuity of 3 lines or more, while 33% of those with newly diagnosed disease had improvements of 3 lines or more. This corresponds to a mean vision of 20/200 at baseline compared with 20/50 posttreatment.

There were significant changes in macular thickness between the pretreatment and posttreatment patients, from a mean of 294 microns to 220 microns.

While repeat injections of Macugen were offered if there was evidence of progression of the CNV lesions, there was little difference between the 2 groups as to the number of patients who needed retreatment and who did not. The mean number of treatments in the group that had received prior treatment was 2.6 and in the group that had no prior therapy it was 2.4.

As far as adverse events were concerned, cataract progression was seen in one third of all phakic patients while 27% developed transient increases in IOP to > 23 mm Hg.

According to the study authors, headed by JM Colina-Luquez MD, ophthalmologist, New England Retina Associates, Hamden, Connecticut, this study proves that this triple therapy regimen is effective and appears to be safe.

While the response rate appears to be greater among patients who had not had prior therapy and whose CNV was newly diagnosed, the procedure offered important clinical benefits for patients even if they had pre-existing disease and had undergone prior treatments.


[Presentation title: Prospective and Preliminary Study Evaluating Triple Therapy of Intravitreal Triamcinolone, Photodynamic Therapy and Pegaptanib Sodium for Choroidal Neovascularization. Poster B1016]

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