Combined treatment modalities in wet AMD

Abstract

Introduction: АМD is a disease of social significance and an increasing incidence. The patients with wet AMD need a life-long treatment in order to sustain useful vision. The Anti-VEGF treatment does not ameliorate the dry component of the disease. That’s why an alternative treatment is highly needed. Aim: To propose an alternative treatment as an adjunct to the standard of care in an attempt to prolong treatment-free intervals, to ameliorate the degenerative process and to suppress tachyphylaxis. Methods: Nanosecond laser (2RT, Ellex) was used as an adjunct to Anti-VEGF treatment in the first group of patients and Triamcynolon subtenonially and Anti-VEGF in the second group. Patients were followed with visual acuity, FA, FAF, OCT, Angio-OCT. Results: 20 patients were followed in the first group-AntiVEGF+2RT. Improvement of BCVA was achieved in 85% (1 to 3 lines on Snellen). In the follow-up-4 months of treatment-free period was maintained in 6 patient; 2 patients had 12 months of treatment free period; 6 patients had 6 months of treatment-free intervals. Ten patients were followed in the 2nd group. Improvement or stabilization of visual acuity and up to 6 months treatment-free intervals were achieved. Amelioration of degenerative cysts in 2/3 of the patients. Conclusion: The combined treatment of wet AMD with Anti-VEGF and 2RT or Anti-VEGF and Triamcynolone subtenonially can ameliorate the degenerative process by tissue stimulation, and suppression of inflammation. It also shows the potential to elongate treatment-free intervals and diminish tachifilaxis.