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E. Chen, M. S. Benz, R. H. Fish, D. M. Brown, T. P. Wong, R. Y. Kim, J. C. Major; Use of Nepafenac (Nevanac) in Combination With Intravitreal Anti-VEGF Agents in the Treatment of Recalcitrant Exudative Macular Degeneration Requiring Monthly Injections. Invest. Ophthalmol. Vis. Sci. 2010;51(13):918.
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To determine the efficacy of combining topical nepafenac with monthly intravitreal injections of ranibizumab or bevacizumab in the treatment of recalcitrant exudative macular degeneration.
This was a retrospective review of patients with exudative macular degeneration requiring maintenance therapy of anti-VEGF injections at least every 6 weeks who were started on topical nepafenac. Despite frequent anti-VEGF dosing, all patients reviewed had persistence of any combination of the following: intraretinal cysts, subretinal fluid, and/or pigment epithelial detachment. Patients underwent pinhole visual acuity, clinical exam, and OCT at baseline and every follow-up visit. Response to therapy was graded by reviewing quantitative and qualitative OCT data.
25 patients (average age 77, 14 male, 11 female) were included in the review. The average number of previous injections was 17.4 (range 3-31). Baseline visual acuity was 20/55 and final visual acuity after three months of treatment was 20/51. Monthly central foveal thickness measurements were 236, 235, 243, and 241 microns at baseline, one month, two months, and three months, respectively. Compared to baseline, qualitative OCT findings on 11 patients treated with nepafenac were classified as stable, 11 as better, and 3 as worse at the three-month time point.
Although there was no significant change in visual acuity or quantitative OCT measurements, there appeared to be a trend toward improved qualitative OCT findings when topical nepafenac was added to monthly anti-VEGF injections in patients with exudative AMD and persistent intraretinal cysts, subretinal fluid and/or pigment epithelial detachment. While this was a retrospective review with a small sample size, these findings may warrant further prospective studies with longer follow-up.
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