title: Bevacizumab and triamcinolone acetonide for choroidal neovascularization due to age-related macular degeneration unresponsive to antivascular endothelial growth factors.
abstract: OBJECTIVE
  To evaluate the safety and efficacy of a combined approach using an antivascular endothelial growth factor (VEGF) agent (bevacizumab) and a steroid (triamcinolone acetonide) for treating choroidal neovascularization (CNV) due to age-related macular degeneration (AMD) unresponsive to anti-VEGF monotherapy.
  
  
  METHODS
  Retrospective case series. We analyzed 25 eyes with CNV due to AMD who received a combination of intravitreal bevacizumab (1 mg) and triamcinolone (4 mg). Results were assessed at 7 days, 1, 3, 6, 9, and 12 months by best-corrected visual acuity (BCVA) measurement, fluorescein angiography, indocyanine green angiography, and optical coherence tomography (OCT). Retreatment with intravitreal bevacizumab or combination therapy was considered at investigator discretion at every follow-up visit.
  
  
  RESULTS
  A mean BCVA improvement of 0.18 (95% CI: 0.05; 0.3) logMAR was reported between baseline and the 12-month measurement (P<0.01). An opposite trend toward progressive loss of BCVA, from 1.08 to 1.31 logMAR, had been observed in the 6 months before starting the combination therapy, in spite of regular treatment with anti-VEGFs (P<0.0001). OCT measurements showed a 139-μm (95% CI: 76; 203) decrease in mean central retinal thickness (P<0.01). On average, patients required 1.8 additional treatments. Five (20%) cases of intraocular pressure elevation were successfully treated with medications.
  
  
  CONCLUSIONS
  Combination therapy with intravitreal bevacizumab and triamcinolone acetonide proved to be a safe and effective option for CNV unresponsive to anti-VEGF monotherapy. The combined treatment reversed the preoperative trend toward losing vision, and a significant anatomic improvement was seen by OCT.
authors.affiliation: Department of Ophthalmology, University of Udine, Udine, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Veritti
authors.forename: Valentina
authors.initials: V
authors.lastname: Sarao
authors.forename: Paolo
authors.initials: P
authors.lastname: Lanzetta
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D000068258:Bevacizumab; D020256:Choroidal Neovascularization / Q000188:drug therapy* / Q000209:etiology; D004359:Drug Therapy, Combination; D005260:Female; D005451:Fluorescein Angiography; D005500:Follow-Up Studies; D006801:Humans; D058449:Intravitreal Injections; D008268:Macular Degeneration / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D014222:Triamcinolone Acetonide / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014792:Visual Acuity / Q000187:drug effects
chemical_list: D020533:Angiogenesis Inhibitors; D000893:Anti-Inflammatory Agents; D061067:Antibodies, Monoclonal, Humanized; D042461:Vascular Endothelial Growth Factor A; D000068258:Bevacizumab; D014222:Triamcinolone Acetonide