[Comments on current therapeutic possibilities for neovascular age-related macula degeneration]

Abstract

Background: New treatments for neovascular age-related macular degeneration have emerged recently, and data from phase III clinical trials are now available. In the light of these data, expert guidance appears prudent to aid ophthalmologists to select the most appropriate therapeutic strategy for the individual patient.

Methods: Therapeutic options discussed include laser photocoagulation, PDT with verteporfin, triamcinolone and its possible combination with PDT, anecortave acetate, pegaptanib and ranibizumab. Treatment principles are described and relevant clinical data summarized.

Recommendations: Extrafoveal classic CNVs should be treated with thermal laser coagulation. For subfoveal lesions with predominantly classic CNV, or occult forms with non-classic CNV, a lesion size < or = 4 macular photocoagulation study (MPS) disc areas (DA) and recent disease progression, PDT with verteporfin is a safe and efficacious treatment. For the remaining subtypes, VEGF inhibitors (pegaptanib, ranibizumab, bevacizumab) for intravitreal use are now available as therapeutic alternatives. The results of the phase III studies for pegaptanib and ranibizumab, however, are not comparable, in particular with reference to the outcomes in the control groups. Since bevacizumab and ranibizumab are comparable in their pharmacological profile bevacizumab may be an alternative in the off-label treatment of neovascular AMD. Reliable data concerning safety and efficacy for bevacizumab, however, are not available and there are no data on combination therapies. The switch to alternative treatment modalities should be considered in particular when the first line treatment is ineffective.

Conclusions: These recommendations provide evidence-based guidance for non-surgical therapies in the management of neovascular AMD. Revisions of the recommendations will be published when new data become available.