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H. Gerding, J. Riese, V. Loukopoulos, C. Meier, U. Thelen, M. Timmermann; Combination With Low-Dose Triamcinolone Prolongs the Effect of Bevacizumab in Patients With Acute Exsudative Age Related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2008;49(13):569.
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To compare the efficacy of bevacizumab alone versus a combination of low-dose triamcinolone and bevacizumab in the treatment of acute exsudative age related macular degeneration.
Retrospective analysis and comparison of visual acuity and OCT central foveal thickness (CFT) in two historical patient groups treated either with bevacizumab (BEV) alone (intravitreal injection of 1.25 mg) or a combination of simultaneous bevacizumab (intravitreal, 1.25 mg) and low-dose (2 mg) intravitreal triamcinolone (BEV+T). Analyzed patient groups (BEV, n=32; BEV+T, n=48) did not present statistically significant differences concerning age and basic disease parameters (type and size of lesion, visual acuity and CFT at study entry). Only treatment naïve patients were analyzed in this study. Follow-up examinations were performed at day 1, day 7, month 1, 2 and 3 after injection including best corrected visual acuity, IOP, slit lamp examination, binocular funduscopy and OCT. Fluorescence angiography was performed before treatment and after 3 months. RFT was measured by a manual cursor procedure.
Visual acuity in the BEV presented a short peak of significant improvement at day 7 after injection (p < 0.02) and was otherwise stabilized at the preoperative level for all visits and towards the end of the follow-up period (final change of +0.04 log lines, range: -6 to + 7 log lines, p=0.27). BEV+T treatment resulted in a significant improvement of visual acuity at 1 month (p<0.005) and borderline significance after 3 months (+0,79 log lines, p<0.065). CFT in BEV eyes was significantly decreased until month 2 (p<0.006) and increased again at month 3 (p=0.14). The decrease of CFT in BEV+T eyes was persisting towards the end of the study period at a p-level of 0.001. 10/32 eyes in the BEV+T group developed a secondary increase of intraocular pressure that was well controlled by local antiglaucomatous therapy. Retreatment was regarded as necessary and performed in 5/32 cases in the BEV group after 2 months and in none of the BEV+T-patients.
This study demonstrates that low-dose intravitreal triamcinolone in addition to bevacizumab is resulting in a prolongation of the functional benefit and reduction of OCT retinal thickness in cases with acute exsudative age related macular degeneration.
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