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J. M. Colina-Luquez, N. A. Chaudhry, P. E. Liggett, G. Haffner, D. Tom; Intravitreal Triamcinolone Acetonide as a Rescue Therapy From Ranibizumab Failure in the Treatment of Age Related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2008;49(13):549. doi: https://doi.org/.
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To report the short-term results on visual and anatomic outcome of intravitreal triamcinolone acetonide in patients with active subfoveal choroidal neovascularization (CNV) from age related macular degeneration despite Ranibizumab treatment.
This retrospective, case series study included 11 patients (13 eyes). Informed consent was obtained and HIPPA requirements were followed. All subfoveal CNV without restriction to type, were treated prior with at least 2 cycles (1 injection every 4 weeks x 3 times/ each cycle) of 0.5mg of intravitreal Ranibizumab; all CNV had persistent activity OCT and/or FA proved; triamcinolone intravitreal injection was performed after 4 weeks of last Ranibizumab injection. All patients had VA measurement (Snellen chart), slit-lamp biomicroscopy with IOP measurement and, 90D ophthalmoscopy, fluorescein angiography and OCT.
Follow-up ranged from 2 to 4 months (mean 3 months). The mean visual acuity change was an improvement of 3.2 lines; 62 % of the eyes had an improvement of 3 or more lines 2 weeks after intravitreal triamcinolone injection was performed, 38% remained stable, none of them decreased visual acuity. The mean macular thickness measured by OCT pre- triamcinolone treatment was 301 + 82.76 (189 to 399 microns); post-treatment OCT was mean 178 + 60.37 (range 135 to 287 micros).This was statistically significant (Wilcoxon signed-rank test, P = .002). During follow-up, 28% of the patients presented increased intraocular pressure (IOP) of > 20 mmHg which was controlled by topical treatment. None of the eyes developed endophthalmitis.
Intravitreal triamcinolone seems to be temporarily effective in improving VA and anatomical configuration of the fovea; it doesn’t seems to prevent recurrence however we feel that It could be used as a co-adjuvant therapy in those patients in whom Ranibizumab therapy hasn’t been efficient for the treatment of ARMD; further research is required.
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