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S. L. Prabakaran, H. Wafapoor, A. M. Eaton; Efficacy of Supplemental Posterior Sub-Tenon’s Triamcinolone Injections in Exudative AMD Unresponsive to Avastin Monotherapy. Invest. Ophthalmol. Vis. Sci. 2009;50(13):966.
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To evaluate the results of treatment with intra-ocular bevacizumab (Avastin) combined with posterior sub-Tenon’s (PST) triamcinolone in patients with age-related macular degeneration who were refractory to intra-ocular Avastin alone.
This is a retrospective study of 34 eyes (34 patients) with exudative macular degeneration. The mean age of the patients was 80 years. All patients were Avastin non-responders (range of 1-20 injections and an average of 7 injections) and were subsequently treated with a combination of Avastin 1.25 mg and a PST containing 40 mg of triamcinolone (Kenalog-40). Patients received a total of three Avastin and PST triamcinolone injections. OCT was performed just prior to each treatment and within 4-8 weeks after the last treatment.
The total average macular volumes at the time of each of the injections and after the last treatment were 7.18 mm3, 7.117 mm3, 7.18 mm3, and 6.628mm3 respectively. The average thickness at the time of each of the injections and after the last treatment were 283.32, 290.2 280.47 and 251.13 respectively. There was an 11% decrease in the average thickness between baseline and after the third injection. A paired t-test was performed on the results of the thickness and volume between the first injection compared to the thickness and volume after the first two injections and there was no significant change. While there was a beneficial trend after the 3rd injection, it did not reach significance (P<=0.06).
The addition of peri-ocular Kenalog to Avastin non-responders resulted in a reduction in their edema based on OCT measurements after the third treatment, which approached but did not reach statistical significance.
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