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Raheleh Rahimi Darabad, Douglas K. Sigford, Tongalp H. Tezel; Adjunctive Antifibrotic Treatment with Intravitreal Triamcinolone Acetonide Enhances the Functional and Anatomical Outcomes of Anti-VEGF Therapy in Exudative Macular Degeneration (ExAMD). Invest. Ophthalmol. Vis. Sci. 2012;53(14):2039.
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To evaluate the effect of adjunctive antifibrotic treatment with triamcinolone acetonide (TA) on the final visual acuity and the size of the subretinal scar in exudative AMD patients treated with bevacizumab.
Previously untreated ExAMD patients (n=10) received a combination of intravitreal bevacizumab (1.25 mg) and TA (2 mg) at every 12 weeks until they reached anatomical and functional stability. Patients that received solely bevacizumab (n=18) and treated with PDT alone (n=3) were used for comparison. Fundus photography, FA and OCT were used to determine the initial size of the neovascular complex (CNV) and the final disciform scar (DS). Change in the size of the CNV and visual acuity was compared between different treatment groups.
31 exAMD patients were treated and followed for 41±24 months. There were no differences between treatment groups comparing patient age (p=0.84), gender (p=0.45), initial VA (p=0.23), follow-up duration (p=0.06) and affected eye (p=0.56). The initial area of the CNV in combined bevacizumab/TA group was significantly larger (15.1±7.8 mm2, p=0.008). Increase in the size of CNV was inversely correlated with its pre-treatment dimension (r=-0.52, p=0.012). Once corrected to the pre-treatment CNV size, patients treated with bevacizumab/TA combination revealed 29.1±54.2% reduction in final lesion area, in contrast to an increase in bevacizumab (170.5±30.7%) and PDT (196.3±61.2%) treatment groups (p=0.001). Final visual acuity as better preserved in the bevacizumab/TA combination group (20/78±20/56) compared to patients treated with bevacizumab (20/224±20/52) and PDT (20/371±20/22, p=0.024).
Adjunctive antifibrotic treatment with corticosteroids reduces the size of the final disciform scar and preserves visual acuity better compared to anti-VEGF therapy alone. Antifibrotic treatment should be included as a part of pharmacotherapy for exAMD.
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