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D.N. Sang, M.S. Hughes; Efficacy and Safety of Combined Triamcinolone Acetonide /Pegaptanib Treatment for Neovascular Age–Related Macular Degeneration . Invest. Ophthalmol. Vis. Sci. 2006;47(13):4249.
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Vascular endothelial growth factor (VEGF) has been validated as a powerful promoter both of angiogenesis and vascular permeability. Selective VEGF blockade with an anti–VEGF165 RNA aptamer, pegaptanib sodium, has been demonstrated to afford both efficacy and safety in the treatment of all angiographic categories of neovascular AMD. As AMD is also believed to have an independent inflammatory component, steroids have been examined as a potential adjunctive treatment, with particular focus on intravitreal triamcinolone acetonide (Kenalog) [IVK]. IVK may have a positive impact on AMD, but its effects when employed alone are transient and often accompanied elevation of intraocular pressure, as well as progression of cataract. There is therefore concern as to the adverse impacts of repeated IVK injections. Pegaptanib, on the other hand, has shown both efficacy and low risk in repeated injections. We have designed a combination treatment regimen for AMD that employs Macugen as a foundation of treatment preceded by pulse IVK.
Twelve patients with a cross section of angiographic subtypes of NV AMD and broad range of baseline vision seen consecutively in an office based practice were treated with IVK initially, followed by Macugen administered according to label. Subjects were monitored with assessments of visual acuity, slit lamp biomicroscopy, dilated funduscopy, FFA, and OCT determinations.
Patients treated with the combination of pulse IVK superimposed upon a foundation of selective VEGF165 blockade afforded results that were superior to results seen with Macugen alone, as determined by a combined assessment of visual acuity, OCT and FFA ancillary testing. Of note was the fact that subtypes of NV AMD with poor prognoses with conventional treatment approaches were found to respond favorably to combination IVK and Macugen.
A regimen of pulse IVK combined with selective VEGF165 blockade may afford better clinical outcomes and continued acceptable safety in the treatment of all angiographic subtypes of AMD. Randomized clinical trials are warranted.
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