Abstract
Purpose: :
Intravitreal (IVT) bevacizumab (Avastin) is an effective treatment for CNV in ARMD, resulting in stabilization and/or improvement of visual acuity in most patients. In a small percentage of patients this is not the case. Combination therapies might be more effective in these patients. Triamcinolone acenotide (TA) can be effective in the treatment of CNV when combined with photodynamic therapy (PDT), and can significantly reduce intravitreal VEGF levels. We present and discuss a series of patients treated with combined IVT Avastin and TA.
Methods: :
12 patients with ARMD and active CNV were treated with a combination of intravitreal Avastin (1.25 mg/ 0.05 ml) and TA (4 mg/ 0.1 ml), administered consecutively within a period of 7 to 14 days. Indication for treatment was a failed response to other therapies, defined as persistent or recurrent subretinal and/or intraretinal fluid on OCT. Response to therapy was determined by visual acuity (VA) and findings on OCT.
Results: :
Patients ranged in age from 66 to 84 years. VA at the time of presentation ranged from 20/25 to CF, with a median of 20/100. Final VA ranged from 20/25 to CF, with a median of 20/50. Lesion size ranged from 0.5 to 5 disc areas (DA), with a median of 2 DA. Most lesions were minimally classic (8/12), three were fibrovascular. Most patients (7/12) had failed multiple treatment modalities which included PDT alone, PDT combined with IVT TA, and IVT Avastin. Five patients had failed IVT Avastin alone at 8 to 6 week intervals, with a mean of 4 injections. All patients responded to combined therapy with complete resolution of subretinal fluid on OCT. Five patients experienced a sustained response without recurrence, and continued therapy with maintenance Avastin at 2 month invervals. Most patients (7/15), however, experienced recurrence of the subretinal fluid within 6-16 weeks (mean 11), and have continued treatment with Avastin at increased frequency or Lucentis (ranibizumab)
Keywords: age-related macular degeneration • choroid: neovascularization • clinical (human) or epidemiologic studies: outcomes/complications