Combined intravitreal bevacizumab and triamcinolone in exudative age-related macular degeneration.
OBJECTIVE
We report on the combined application of intravitreal bevacizumab and triamcinolone acetonide for treatment of exudative age-related macular degeneration (AMD).


METHODS
The clinical interventional case-series study included 16 patients (16 eyes) with exudative AMD who had previously received 3.5±1.8 mono-injections of bevacizumab (1.5mg) without significant improvement in visual acuity (VA) or reduction in macular exudation. All patients underwent a combined intravitreal injection of bevacizumab (1.5mg) and triamcinolone acetonide (about 20mg). Main outcome measures were VA and macular thickness as determined by optical coherence tomography. All patients were re-examined at 2-3months after the intervention.


RESULTS
Visual acuity improved significantly (p=0.03) from 0.80±0.40 logMAR prior to the combined injection to 0.65±0.42 logMAR at 3 months after the injection. An improvement of ≥1Snellen line was found in eight subjects, an increase of ≥2lines in five subjects, and an improvement of ≥3lines in two subjects. One patient lost 1line and one patient lost 3lines. Central retinal thickness decreased significantly from 272±62μm to 220±47μm (p=0.03). At the 6-month follow-up examination, central retinal thickness had increased again to 319±142μm, which was not significantly (p=0.30) different from baseline measurements.


CONCLUSIONS
The combined intravitreal application of bevacizumab and triamcinolone may temporarily be helpful in the treatment of exudative AMD if previous intravitreal bevacizumab mono-injections have failed to improve vision and reduce macular oedema.
Department of Ophthalmology, Medical Faculty Mannheim, Ruprecht-Karls-University of Heidelberg, Mannheim, Germany.
Jost B
JB
Jonas
Teodosio
T
Libondi
Lidia
L
Golubkina
Ulrich H
UH
Spandau
Frank
F
Schlichtenbrede
Florian
F
Rensch
D000368:Aged; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D000068258:Bevacizumab; D004359:Drug Therapy, Combination; D005122:Exudates and Transudates; D005260:Female; D005451:Fluorescein Angiography; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D058449:Intravitreal Injections; D008268:Macular Degeneration / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D012160:Retina / Q000473:pathology; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D014222:Triamcinolone Acetonide / Q000627:therapeutic use*; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014792:Visual Acuity / Q000502:physiology
D020533:Angiogenesis Inhibitors; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D005938:Glucocorticoids; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D000068258:Bevacizumab; D014222:Triamcinolone Acetonide