Intravitreal bevacizumab combined with intravitreal triamcinolone for therapy-resistant exudative age-related macular degeneration.
OBJECTIVE
To investigate the effect of intravitreal bevacizumab (IVB) combined with intravitreal high-dose triamcinolone acetonide (IVTA) for therapy of exudative age-related macular degeneration (AMD) after unsuccessful IVB monotherapy.


METHODS
The prospective study included 29 White patients (31 eyes) who consecutively received IVB (1.5 mg) plus high-dose IVTA (20-25 mg) for exudative AMD, after they had received multiple IVB mono-injections without functional and anatomical success. Two additional IVB injections were given in intervals of 2 months after the combined injection. The main outcome parameters were best-corrected visual acuity (BCVA) and data measured by optic coherence tomography (OCT).


RESULTS
Mean BCVA (LogMAR) improved from 0.70 + or - 0.37 LogMAR at baseline to 0.59 + or - 0.38 LogMAR at 2 months after first follow-up (P = 0.004) and to 0.63 + or - 0.41 LogMAR (P = 0.04) at 4 months after baseline. It deteriorated to 0.68 + or - 0.41 at the end of the follow-up at 7 months after the combined injection, without a significant (P = 0.53) difference to the baseline visual acuity. The maximum macular thickness decreased significantly from 371 + or - 206 microm at baseline to 322 + or - 90 microm (P = 0.04) at the first follow-up and to 316 + or - 90 microm (P = 0.03) at the second follow-up. It slightly increased toward the end of follow-up (333 + or - 133 microm; P = 0.16). Intraocular pressure increased marginally significantly (P = 0.06) from 14.5 + or - 2.8 mm Hg to 15.7 + or - 3.3 mm Hg at the second follow-up.


CONCLUSIONS
Patients with exudative AMD, in whom monotherapy with IVB was unsuccessful, may experience a temporary improvement in vision and reduction in macular thickness after a combined intravitreal injection of bevacizumab and triamcinolone.
Tao
Yong
Y
Department of Ophthalmology, Medical Faculty Mannheim of the Ruprecht-Karls-University, Heidelberg, Germany.
Jonas
Jost B
JB
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; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D005122:Exudates and Transudates; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007267:Injections; D007429:Intraocular Pressure; D008268:Macular Degeneration / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012160:Retina / Q000473:pathology; D019233:Retreatment; D014222:Triamcinolone Acetonide / Q000008:administration & dosage*; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors*; D014792:Visual Acuity / Q000502:physiology; D014822:Vitreous Body
D020533:Angiogenesis Inhibitors; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D005938:Glucocorticoids; D042461:Vascular Endothelial Growth Factor A; D000068258:Bevacizumab; D014222:Triamcinolone Acetonide