AIM:To evaluate photodynamic therapy (PDT) combined with the preferential the cyclooxygenase-2 (COX-2) inhibitor, nabumetone in the treatment of the neovascular age-related macular degeneration (ARMD). METHODS:A prospective, double-blind, randomized study on 60 patients with subfoveal CNV secondary to ARMD without any previous treatment. Patients were divided into a nabumetone or placebo group. The main endpoints were the change of best-corrected visual acuity (BCVA), central macular thickness (CRT) and number of required PDT treatments. RESULTS:In the nabumetone group, 27 patients (90%) and 28 (93%) in the placebo group completed the follow-up of 12 months. In the nabumetone group, the mean CRT decreased from 332 μm (SD 68 μm) to 220 μm (SD 46 μm). In the placebo group, CRT decreased from 331 μm (SD 72 μm) to 254 μm (SD 61 μm). The mean BCVA was 0.68 log MAR (SD 0.22 log MAR) in the nabumetone group and 0.62 log MAR (SD 0.23 log MAR) in the placebo group at baseline. This stabilised in the placebo group to 0.66 log MAR (SD 0.33) but deteriorated in the nabumetone group to 0.86 log MAR (SD 0.41 log MAR). There was a significant reduction in the number of required PDTs in the nabumetone group, but significant progression of the RPE atrophy area. CONCLUSION:Combined PDT with oral intake of the COX-2 inhibitor, nabumetone reduced the number of required PDT retreatments, but worsening BCVA caused by macular atrophy progression. Therefore the combination of the PDT with the nabumetone is not recommended.

译文

目的:评估光动力疗法(PDT)与优先使用环氧合酶-2(COX-2)抑制剂萘丁美酮的组合,以治疗新生血管性年龄相关性黄斑变性(ARMD)。
方法:一项前瞻性,双盲,随机对照研究,对60例继发于ARMD继发于中央凹下的CNV患者而未进行任何治疗。将患者分为萘丁美酮或安慰剂组。主要终点是最佳矫正视力(BCVA),中央黄斑厚度(CRT)和所需PDT治疗次数的改变。
结果:萘丁美通组中,安慰剂组27例(90%)和28例(93%)完成了12个月的随访。在萘丁美酮组中,平均CRT从332μm(SD 68μm)降至220μm(SD 46μm)。在安慰剂组中,CRT从331μm(SD 72μm)降至254μm(SD 61μm)。萘丁美tone组的平均BCVA为0.68 log MAR(SD 0.22 log MAR),而安慰剂组的基线BCVA为0.62 log MAR(SD 0.23 log MAR)。这在安慰剂组中稳定至0.66 log MAR(SD 0.33),但在萘丁美通组中恶化至0.86 log MAR(SD 0.41 log MAR)。萘丁美通组中所需PDT的数量显着减少,但RPE萎缩区域进展明显。
结论:萘丁美酮与PDT结合口服摄入COX-2抑制剂相结合,减少了所需的PDT再治疗次数,但由于黄斑萎缩的进展而使BCVA恶化。因此,不建议将PDT与萘丁美酮组合使用。

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