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D. J. Jacobs, A.-D. T. Phan, K. M. Bowman, J. Z. Forsey, G. B. Russell; Supplementing Ranibizumab (Lucentis) With Intravitreal Triamcinolone (Kenalog) for Fibrovascular Pigment Epithelial Detachment in Neovascular AMD. Invest. Ophthalmol. Vis. Sci. 2009;50(13):1929.
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To evaluate the effect of supplementing Lucentis with intravitreal Kenalog (L+K) compared to Lucentis alone (L) for fibrovascular pigment epithelial detachment (PED) in neovascular AMD.
IRB-approved retrospective, comparative chart and diagnostic testing review of patients with neovascular AMD having fibrovascular PED treated with monthly L or monthly L initially supplemented with K (L+K). Inclusion criteria were fibrovascular PED with active leakage confirmed by FA and OCT, no prior Lucentis or Avastin within 1 month or steroid within 3 months of starting treatment, Kenalog administered during initial treatment period, Snellen BCVA of 20/400 or better, and at least 3 months of follow-up. Primary outcome measure was time to leakage resolution. Secondary outcome measures were mean number of treatments to leakage resolution, Snellen letter change, OCT CFT change, and incidence of increased IOP. Differences between groups were assessed using the Wilcoxon two-sample test.
6 patients received L and 8 patients received L+K. Mean baseline Snellen VA and lesion size were comparable in the two groups, 20/79 and 2.7 DA in the L group, 20/75 and 3.3 DA in the L+K group. 3-month mean Snellen letter (and logMAR) change and OCT CFT change for L vs. L+K were similar between groups, specifically, +4.3 letters (logMAR -0.12) vs. +4.5 letters (logMAR -0.13), and -63 µm vs. -80 µm, respectively. To achieve leakage resolution, the L+K group was statistically significantly faster requiring a mean 3.5 (SD +/- 0.8) months using mean 3.6 treatments vs. the L group which required 4.5 (+/- 0.8) months (p=0.045) using 4.3 treatments, p=0.107. More L+K patients (4/8) than L patients (0/6) only required 3 treatments for leakage resolution, p=0.09. No patients developed an IOP spike.
Supplementing Lucentis with intravitreal Kenalog early term for fibrovascular PED may hasten the achievement of leakage resolution while providing a comparable improvement in vision to Lucentis alone. There was a tendency of requiring less Lucentis injections when intravitreal Kenalog was on-board.
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