March 2012
Volume 53, Issue 14
Free
ARVO Annual Meeting Abstract  |   March 2012
Adjunctive Antifibrotic Treatment with Intravitreal Triamcinolone Acetonide Enhances the Functional and Anatomical Outcomes of Anti-VEGF Therapy in Exudative Macular Degeneration (ExAMD)
Author Affiliations & Notes
  • Raheleh Rahimi Darabad
    Department of Ophthalmology and Visual Sciences,
    University of Louisville, Kentucky Lions Eye Center, Louisville, Kentucky
  • Douglas K. Sigford
    Department of Ophthalmology and Visual Sciences,
    University of Louisville, Kentucky Lions Eye Center, Louisville, Kentucky
  • Tongalp H. Tezel
    Department of Ophthalmology and Visual Sciences,
    Anatomical Sciences and Neurobiology,
    University of Louisville, Kentucky Lions Eye Center, Louisville, Kentucky
  • Footnotes
    Commercial Relationships  Raheleh Rahimi Darabad, None; Douglas K. Sigford, None; Tongalp H. Tezel, None
  • Footnotes
    Support  Supported in part by an unrestricted grant from Research to Prevent Blindness, Inc, NYC, NY.
Investigative Ophthalmology & Visual Science March 2012, Vol.53, 2039. doi:
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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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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose: : 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.

Methods: : 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.

Results: : 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).

Conclusions: : 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.

Keywords: age-related macular degeneration • choroid: neovascularization • drug toxicity/drug effects 
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