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D. Veritti, V. Sarao, C. Savorgnani, G. Polini, P. Lanzetta; Combination Therapy for Choroidal Neovascularization Due to Age-Related Macular Degeneration Unresponsive to Anti-VEGF Monotherapy. Intravitreal Bevacizumab and Triamcinolone Acetonide. Invest. Ophthalmol. Vis. Sci. 2010;51(13):104.
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To evaluate the safety and exploratory efficacy of combination therapy with intravitreal bevacizumab and intravitreal triamcinolone acetonide in choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD) unresponsive to anti-VEGF monotherapy.
Ten sequential eyes with CNV due to AMD were included in this retrospective chart review. They received a single session combination of intravitreal bevacizumab (1 mg/ 0.04 ml) and triamcinolone acetonide (4 mg/ 0.1 ml). Indication for treatment was a failed response to anti-VEGF monotherapies, defined as persistent or recurrent subretinal and/or intraretinal fluid on optical coherence tomography (OCT). Patients received monthly follow-up examinations after treatment. Best corrected visual acuity (BCVA), fluorescein angiography (FA), indocyanine green angiography (ICGA) and OCT were performed at every follow-up visit.
Mean follow-up is 4.8 months. Each patient received a mean of 6 intravitreal anti-VEGF agent injections before enrollment. Mean BCVA (±SD) was 1.27 (±0.5) logMAR and 1.06 (±0.5) logMAR at baseline and at the end of follow-up respectively. Mean central retinal thickness (±SD) was 441.8 (±44.1) µm at baseline and 316.4 (±130.3) µm at the end of follow-up [p=0.014]. Two patients experienced reactivation of CNV lesion within the follow-up period and required an additional combined treatment or a anti-VEGF injection alone. Five eyes (50%) showed no sign of any fluid at the end of the follow-up. Two eyes (20%) required topical treatment due to significant intraocular pressure increase.
The combination of intravitreal bevacizumab and triamcinolone acetonide is a safe treatment option for CNV due to AMD and can potentially offer a new treatment modality for neovascular lesions not responding to anti-VEGF monotherapy. Further studies are needed to evaluate functional results.
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