Triple Combination Therapy for Anti-VEGF Nonresponders
A Retrospective Case Series

1. Jacob C. Lee
2. Wai-Ching Lam

Toronto Western Hospital, Toronto, Ontario, Canada

Purpose: To report the effects of triple combination therapy with verteporfin photodynamic therapy (PDT), anti-vascular endothelial growth factor (anti-VEGF), and dexamethasone on a series of patients with neovascular AMD non-responsive to anti-VEGF monotherapy.

Methods: This is a retrospective, observational, single center case series of twelve consecutive patients who failed anti-VEGF monotherapy and subsequently received combination triple therapy with PDT, anti-VEGF, and intravitreal dexamethasone from October 2008 to October 2010. Outcome measures were change in central foveal thickness (CFT) as measured by optical coherence tomography (OCT) and visual acuity stability, as defined as loss of less than 15 ETDRS letters or 3 Snellen lines of vision, at the three month follow up visit.

Results: Patients who demonstrated poor anatomical response to regular intravitreal anti-VEGF injections for a minimum of 3 months were offered triple therapy with verteporfin half-fluence PDT, anti-VEGF, and intravitreal dexamethasone. The mean number of injections prior to initiation of triple combination therapy was 9.67. The mean change in central foveal thickness at the three month follow up visit was – 137.58 microns. 75% of the patients had decreased CFT at the three month follow up visit, and 92.3% maintained stable vision.

Conclusions: Previous studies investigated combination therapy and found limited statistical differences between combination therapy and monotherapy ranibizumab when used as the primary treatment. Our case series shows, patients who fail to demonstrate an appropriate response to anti-VEGF monotherapy may benefit with an anatomic response and visual stability from triple combination therapy.