Effect of intravitreal triamcinolone acetonide injections on persistent sub-retinal fluid in wet-AMD patients receiving conventional anti-VEGF therapy

Abstract

Purpose : The use of steroid injections in wet age-related macular degeneration (AMD) has largely been abandoned with the advent of anti-VEGF treatments. Combinations of intravitreal triamcinolone acetonide (IVTA) injections with photodynamic therapy have been extensively studied, however the use of IVTA in conjunction with anti-VEFG for sub-retinal fluid has yet to be explored. We performed a retrospective, observational clinical study to evaluate the role of IVTA injections on sub-retinal fluid and visual acuity in wet-AMD patients who have persistent sub-retinal fluid despite ongoing conventional anti-VEGF treatments.

Methods : Retrospective chart review of 11 patients (12 eyes) who received IVTA injections after monthly anti-VEGF injection treatment with persistent sub-retinal fluid from November 2015 to June 2017. En Face Optical Coherence Tomography Imaging was used to measure the area of sub-retinal fluid prior to IVTA treatment, and after 1, 2 and 3 treatments with IVTA injections. Statistical analysis was performed using paired sample t-tests. Outcome measures include changes in sub-retinal fluid area and LogMAR uncorrected visual acuity.

Results : The mean sub-retinal fluid area before IVTA treatment was 8.68mm² (±2.06), and after 1, 2 and 3 IVFA treatments were 8.28mm² (±2.39), 4.28mm² (±1.72) and 4.03mm² (±1.62) respectively. Sub-retinal fluid area had a downward trend with IVTA treatments, with a statistically significant decrease in sub-retinal fluid area after two IVTA injections (p=0.04). Mean uncorrected logMAR visual acuity before treatment was 0.595 (±0.071), and after 1, 2 and 3 IVTA treatments were 0.585 (±0.093), 0.527 (±0.075) and 0.541 (±0.084) respectively. The change in mean uncorrected logMAR visual acuity with IVTA treatments trended towards improvement, and was statistically significant with two IVTA treatments (p=0.037).

Conclusions : Our results demonstrate that sub-retinal fluid area decreases and visual acuity improves after two IVTA injections in wet AMD patients resistant to anti-VEGF therapy alone. However, results were only significant after the second IVTA injections. Larger sample sizes and prospective clinical trials are necessary to further explore the potential benefit of IVTA as an inexpensive and possibly effective addition to anti-VEGF treatment of wet AMD in those patients with persistent sub-retinal fluid.

This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.