Triple Therapy for Anti-Vascular Endothelial Growth Factor Nonresponders in Neovascular Age-Related Macular Degeneration: Impact of Different Photodynamic Therapy Parameters

Abstract

Purpose: To evaluate the safety and exploratory efficacy of triple therapy (TT) with single-session intravitreal ranibizumab, modified juxtascleral triamcinolone, and photodynamic therapy (PDT) in exudative age-related macular degeneration non-responder to anti-vascular endothelial growth factor. Methods: Thirty consecutive eyes were included. The first 10 eyes (cohort 1) enrolled received same-day TT with reduced-fluence/reduced-irradiance PDT, 10 eyes (cohort 2) received same-day TT with reduced-fluence/standard irradiance PDT, the last 10 eyes (cohort 3) received same-day TT with standard fluence/standard irradiance PDT. Results: All patients completed the 6-month follow-up. Mean best corrected visual acuity (BCVA) at baseline was 1.1 (cohort 1), 0.9 (cohort 2) and 1.1 (cohort 3) logMAR. After 6 months, mean BCVA change was -0.15 (not significant), -0.13 (not significant) and 0.29 (p < 0.05) logMAR, respectively. Among eyes treated with standard fluence/standard irradiance PDT, 2 showed choroidal ischemia. Conclusions: The combination of modified juxtascleral triamcinolone, reduced-fluence PDT, and ranibizumab appears as a safe treatment option.