Friday, November 21, 2008
Dr. Albert J. Augustin from the University of Mainz in Germany discusses treatment strategies against choroidal neovascularization (CNV) in a conversation with retina specialist, Dr. Sophie Bakri. Dr. Augustine defines the combination therapy parameters currently in use at his institution to combat CNV.
His version of triple therapy consists of a modified photodynamic therapy (with reduced light dose of 73 seconds from 80) followed by an intravitreal injection of dexamethasone (800 mcg) and Avastin (2mg). In lesions that are somewhat fibrotic, 1mg of triamcinolone is added. They no longer do a limited vitrectomy to compensate for drug volume.
Early results show that visual acuity increase is maintained (~2.5 lines at 79 weeks). Retreatment with a complete triple cycle was needed in 7 patients. 30 patients received a second Avastin injection during the follow-up period. Treatment guidelines allow for monotherapy reimbursement, therefore combination therapy is not an option for many patients who rely on the public medical system.
The future of treatment for macular degeneration seems to be focusing on various monotherapies, but combination therapy is inevitable with anti-VEGF (anti-cytokine agent), anti-inflammatories, and other agents that directly combat CNV.