A review of treatments for macular degeneration: A synopsis of currently approved treatments and ongoing clinical trials

Current Opinion in Ophthalmology

Volumn 15, Issue 3, 2004, Pages 221-226

  Liu, Mimi ^a   Regillo, Carl D ^a  

^a WILLS EYE HOSPITAL   (United States)

Author keywords

Age related macular degeneration; Choroidal neovascularization; Macular translocation; Photodynamic therapy; Transpupillary thermotherapy

Indexed keywords

ANECORTAVE; BENZOPORPHYRIN DERIVATIVE; PEGAPTANIB; STEROID; TRIAMCINOLONE ACETONIDE; VASCULOTROPIN ANTIBODY;

ANGIOGENESIS; CLINICAL TRIAL; CORTICOSTEROID THERAPY; DRUG EFFECT; DRUG EFFICACY; DRUG SAFETY; FOLLOW UP; HUMAN; HYPERTHERMIC THERAPY; PHOTODYNAMIC THERAPY; PIGMENT EPITHELIUM; PRIORITY JOURNAL; RETINA BLOOD VESSEL; RETINA DETACHMENT; RETINA MACULA AGE RELATED DEGENERATION; RETINA MACULA TRANSLOCATION; REVIEW; SIDE EFFECT; SUBRETINAL NEOVASCULARIZATION; VISUAL ACUITY;

ANGIOGENESIS INHIBITORS; CHOROIDAL NEOVASCULARIZATION; CLINICAL TRIALS; HUMANS; HYPERTHERMIA, INDUCED; MACULAR DEGENERATION; OPHTHALMOLOGIC SURGICAL PROCEDURES; PHOTOCHEMOTHERAPY;

EID: 2442587703     PISSN: 10408738     EISSN: None     Source Type: Journal    
DOI: 10.1097/01.icu.0000122122.24016.f1     Document Type: Review

References (26)

1. Schmidt-Erfurth U, Miller JW, Sickenberg M, et al.: Photodynamic therapy with verteporfin for choroidal neovascularization caused by age-related macular degeneration: results of retreatments in a phase 1 and 2 study. Arch Ophthalmol 1999, 117:1177-1187.
2. Macular Photocoagulation Study Group: Laser photocoagulation of subfoveal neovascular lesions in age-related macular degeneration. Results of a randomized clinical trial. Macular Photocoagulation Study Group. Arch Ophthalmol 1991, 109:1220-1231.
3. Macular Photocoagulation Study Group: Laser photocoagulation of subfoveal neovascular lesions of age-related macular degeneration. Updated findings from two clinical trials. Macular Photocoagulation Study Group. Arch Ophthalmol 1993, 111:1200-1209.
4. Treatment of Age-Related Macular Degeneration with Photodynamic Therapy (TAP) Study Group: Photodynamic therapy of subfoveal choroidal neovascularization in age-related macular degeneration with verteporfin: one-year results of 2 randomized clinical trials-TAP report. Arch Ophthalmol 1999, 117:1329-1345.
5. Bressler NM: Treatment of Age-Related Macular Degeneration with Photodynamic Therapy (TAP) Study Group: Photodynamic therapy of subfoveal choroidal neovascularization in age-related macular degeneration with verteporfin: two-year results of 2 randomized clinical trials-TAP report 2. Arch Ophthalmol 2001, 119:198-207.
6. Bressler NM, Arnold J, Benchaboune M, et al.: Verteporfin therapy of subfoveal choroidal neovascularization in patients with age-related macular degeneration: additional information regarding baseline lesion composition's impact on vision outcomes-TAP report no. 3. Arch Ophthalmol 2002, 120:1443-1454.
7. Blinder KJ, Bradley S, Bressler NM, et al.: Effect of lesion size, visual acuity, and lesion composition on visual acuity change with and without verteporfin therapy for choroidal neovascularization secondary to age-related macular degeneration: TAP and VIP report no. 1. Am J Ophthalmol 2003, 136:407-418. These exploratory analyses of patients among three placebo-controlled, randomized clinical trials found a significant treatment-by-lesion-size interaction for minimally classic and occult with no classic lesions, but not for predominantly classic lesions. Smaller (4.0 disc areas or less) minimally classic and occult with no classic lesions had similar visual acuity outcomes to those observed in predominantly classic lesions. The strengths of this study include its prospective, randomized design and large sample size.
8. Thach AB, Sipperley JO, Dugel PU, et al.: Large-spot size transpupillary thermotherapy for the treatment of occult choroidal neovascularization associated with age-related macular degeneration. Arch Ophthalmol 2003, 121:817-820. This prospective, nonrandomized, nonmasked case series studied 69 consecutive patients with predominantly occult CNV treated with TTT using a spot size of 3000 to 6000 μm. At 6 to 12 months of follow-up, 71% of patients had stable visual acuity.
9. Algvere PV, Libert C, Lindgarde G, et al.: Transpupillary thermotherapy of predominantly occult choroidal neovascularization in age-related macular degeneration with 12 months follow-up. Acta Ophthalmol Scand 2003, 81:110-117. This phase I/II study comprised 113 patients with predominantly occult CNV. TTT generally prevents moderate and severe visual loss at 12 months of follow-up in occult-only CNV. However, minimally classic lesions of more than 3.0 mm responded poorly in this treatment setting.
10. Lai JC, Lapolice DJ, Stinnett SS, et al.: Visual outcomes following macular translocation with 360-degree peripheral retinectomy. Arch Ophthalmol 2002, 120:1317-1324.
11. Park CH, Toth CA: Macular translocation surgery with 360-degree peripheral retinectomy following ocular photodynamic therapy of choroidal neovascularization. Am J Ophthalmol 2003, 136:830-835. This is a retrospective review of eight patients who underwent MTS360 after prior PDT found that MTS360 may benefit patients who are continuing to lose vision in their better seeing eye after PDT, especially in patients who had previously under gone only one PDT session.
12. Wolf S, Lappas A, Weinberger AW, et al.: Macular translocation for surgical management of subfoveal choroidal neovascularization in patients with AMD: first results. Graefes Arch Clin Exp Ophthalmol 1999, 237:51-57.
13. Eckardt C, Eckardt U, Conrad HG: Macular rotation with and without counter-rotation of the globe in patients with age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol 1999, 237:313-325.
14. Aisenbrey S, Lafaut BA, Szurman P, et al.: Macular translocation with 360 degrees retinotomy for exudative age-related macular degeneration. Arch Ophthalmol 2002, 120:451-459.
15. Yannuzzi LA, Negrao S, Iida T, et al.: Retinal angiomatous proliferation in age-related macular degeneration. Retina 2001, 21:416-434.
16. Yannuzzi LA, Negrao S, Lida T, et al.: Retinal choroidal anastomoses and occult choroidal neovascularization in age-relatad macular degeneration. Ophthalmology 2000, 107:742-753.
17. Borrillo JL, Sivalingam A, Martidis A, et al.: Surgical ablation of retinal angiomatous proliferation. Arch Ophthalmol 2003, 121:558-561. This pilot study of four eyes with stage 2 RAP found that surgical ablation of feeder vessels may result in improvement of visual acuity associated with resolution of intraretinal edema and flattening of associated pigment epithelial detachment.
18. Penfold PL, Wen L, Madigan MC, et al.: Triamcinolone acetonide modulates permeability and intercellular adhesion molecule-1 (ICAM-1) expression of the ECV304 cell line: implications for macular degeneration. Clin Exp Immunol 2000, 121:458-465.
19. Gillies MC, Simpson JM, Luo W, et al.: A randomized clinical trial of a single dose of intravitreal triamcinolone acetonide for neovascular age-related macular degeneration: one-year results. Arch Ophthalmol 2003, 121:667-673. This double-masked, placebo-controlled, randomized clinical trial included 151 eyes with CNV with any classic component undergoing a single dose of 4 mg IVT. There was no difference between the two groups for the development of severe visual loss during the first year of the study, although change in size of the CNV was significantly less in eyes receiving triamcinolone at 3 months. Strengths of the study include the randomized design. Repeat dosing may have resulted in a sustained biologic effect.
20. Jonas JB, Kreissig I, Hugger P, et al.: Intravitreal triamcinolone acetonide for exudative age related macular degeneration. Br J Ophthalmol 2003, 87:462-468. This prospective interventional case series found that 25 mg IVT once or repeatedly increased visual acuity in 66.2% of eyes with CNV secondary to AMD.
21. Spaide RF, Sorenson J, Maranan L: Combined photodynamic therapy with verteporfin and intravitreal triamcinolone acetonide for choroidal neovascularization. Ophthalmology 2003, 110:1517-1525. In this pilot study with 26 patients, improved visual acuity and the lack of fluorescein leakage was observed in patients undergoing combination therapy with PDT and IVT. Visual outcome was better in patients without prior PDT.
22. D'Amico DJ, Goldberg MF, Hudson H, et al.: Anecortave acetate as monotherapy for the treatment of subfoveal lesions in patients with exudative age-related macular degeneration (AMD): interim (month 6) analysis of clinical safety and efficacy. Retina 2003, 23:14-23. This randomized, prospective study showed that treatment with a single dose of 15 mg anecortave acetate in a juxtascleral injection resulted in superior preservation of visual acuity compared with placebo. Statistical significance was achieved in the subgroup with predominately classic lesions. Strengths of this study include its design, the less invasive nature of the treatment, and the relatively long duration of action of the drug.
23. The Anecortave Acetate Clinical Study Group: Anecortave acetate as monotherapy for treatment of subfoveal neovascularization in age-related macular degeneration: twelve-month clinical outcomes. Ophthalmology 2003, 110:2372-2383. At month 12, anecortave acetate (15 mg) administered at 6-month intervals was statistically superior to the placebo for three measures of clinical efficacy: mean change from baseline vision, stabilization of vision, and prevention of severe vision loss. Anecortave acetate (15 mg) trended toward significance over the placebo at month 12 for inhibition of total lesion growth and for inhibition of both the total CNV component and the classic CNV component in both the overall and subgroup analyses. There was a 41% patient exit rate before month 12.
24. Eyetech Study Group: Anti-vascular endothelial growth factor therapy for subfoveal choroidal neovascularization secondary to age-related macular degeneration: phase II study results. Ophthalmology 2003, 110:979-986. This phase II multiple-injection study of 21 patients treated with EYE001 with and without PDT found no drug-related serious adverse events. At 3 months after treatment, 87.5% of patients who received the anti-VEGF aptamer alone showed stabilized or improved vision. Visual improvement was greater in patients receiving EYE001 and PDT.
25. Krzystolik MG, Afshari MA, Adamis AP, et al.: Prevention of experimental choroidal neovascularization with intravitreal anti-vascular endothelial growth factor antibody fragment. Arch Ophthalmol 2002, 120:338-346.
26. Eyetech Study Group: Preclinical and phase 1A clinical evaluation of an anti-VEGF pegylated aptamer (EYE001) for the treatment of exudative age-related macular degeneration. Retina 2002, 22:143-152.