title: Combined intravitreal pharmacosurgery in patients with occult choroidal neovascularization secondary to wet age-related macular degeneration.
abstract: OBJECTIVE
  The aim was to investigate the efficacy and safety of combined intravitreal therapy in patients with occult choroidal neovascularization (CNV) secondary to wet age-related macular degeneration (AMD) over 6 months.
  
  
  METHODS
  In this prospective pilot study of a case series, 106 patients (mean age 75.4 years) with predominantly occult CNVs were treated with a 1.5-ml core pars plana vitrectomy with intravitreal injections of triamcinolone (8 mg), bevacizumab (1.25 mg) and balanced salt solution. The best-corrected visual acuity (BCVA; logMar), central macular thickness (optical coherence tomography), and intraocular pressure (IOP; Goldmann tonometry) were assessed at baseline and follow-up visits.
  
  
  RESULTS
  Statistically significant increases in BCVA (vs. baseline) were observed at 2 months (mean +0.9; standard deviation +/-0.6 lines), 4 months (+1.3; +/-0.7), and 6 months (+1.2; +/-0.7) after the initial combined intravitreal therapy in 96/106 patients. At 6 months, BCVA had deteriorated in 20 of 96 (20.8%) patients by <2.5 lines, remained stable in 38 of 96 (39.6%) and improved in 31 (32.3%) patients by 1-3 lines, and in 7 (7.3%) patients by >3 lines. The mean central retinal thickness decreased by -41.2% (-195; +/-46 microm) over 6 months. 55% demanded intravitreal anti-vascular endothelial growth factor (VEGF) treatment after initial therapy. Increases in IOP were managed by eye drops in 11 (10%) patients with no other adverse event occurring.
  
  
  CONCLUSIONS
  After the combined intravitreal therapy, including two drugs and a limited core vitrectomy, a significant and sustained improvement in vision of patients with occult CNVs was observed over 6 months. In 45% of the initially treated patients, anti-VEGF therapy did not have to be continued, which might be attributed to both the pharmacological effects of the drugs and the physiological changes induced by the vitrectomy (posterior vitreous detachment, liquefaction, and oxygen redistribution).
authors.affiliation: Department of Ophthalmology, Goethe University, Frankfurt am Main, Germany. michael.koss@kgu.de
authors.forename: M J
authors.initials: MJ
authors.lastname: Koss
authors.forename: S
authors.initials: S
authors.lastname: Scholtz
authors.forename: Y
authors.initials: Y
authors.lastname: Haeussler-Sinangin
authors.forename: P
authors.initials: P
authors.lastname: Singh
authors.forename: F H
authors.initials: FH
authors.lastname: Koch
mesh_terms: D000085:Acetates / Q000008:administration & dosage*; D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage; D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D061067:Antibodies, Monoclonal, Humanized; D000068258:Bevacizumab; D020256:Choroidal Neovascularization / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D003131:Combined Modality Therapy; D004338:Drug Combinations; D004359:Drug Therapy, Combination; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D008903:Minerals / Q000008:administration & dosage*; D010865:Pilot Projects; D011446:Prospective Studies; D012965:Sodium Chloride / Q000008:administration & dosage*; D014222:Triamcinolone Acetonide / Q000008:administration & dosage*; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014792:Visual Acuity / Q000502:physiology; D014821:Vitrectomy; D014822:Vitreous Body; D057135:Wet Macular Degeneration / Q000150:complications / Q000503:physiopathology / Q000628:therapy*
chemical_list: D000085:Acetates; D020533:Angiogenesis Inhibitors; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; C030660:BSS solution; D004338:Drug Combinations; D005938:Glucocorticoids; D008903:Minerals; D042461:Vascular Endothelial Growth Factor A; D000068258:Bevacizumab; D012965:Sodium Chloride; D014222:Triamcinolone Acetonide