Intravitreal injection of triamcinolone combined with bevacizumab for choroidal neovascularization associated with large retinal pigment epithelial detachment in age-related macular degeneration

• Published in: Graefe's archive for clinical and experimental ophthalmology Vol. 248; no. 6; pp. 779 - 784
• Main Authors: el Matri, Leila, Chebil, Ahmed, Kort, Fadra, Bouraoui, Rym, Baklouti, Karim, Mghaieth, Fatma
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 01-06-2010; Springer Nature B.V
• Subjects: Aged; Aged, 80 and over; Angiogenesis Inhibitors - administration & dosage; Angiogenesis Inhibitors - adverse effects; Antibodies, Monoclonal - administration & dosage; Antibodies, Monoclonal - adverse effects; Antibodies, Monoclonal, Humanized; Bevacizumab; Choroidal Neovascularization - drug therapy; Choroidal Neovascularization - physiopathology; Coloring Agents; Drug Therapy, Combination; Female; Fluorescein Angiography; Follow-Up Studies; Glucocorticoids - administration & dosage; Glucocorticoids - adverse effects; Humans; Indocyanine Green; Injections; Macular degeneration; Macular Degeneration - drug therapy; Macular Degeneration - physiopathology; Male; Medicine; Medicine & Public Health; Middle Aged; Ophthalmology; Prognosis; Prospective Studies; Retinal Detachment - drug therapy; Retinal Detachment - physiopathology; Retinal Disorders; Retinal Pigment Epithelium - pathology; Retreatment; Tomography, Optical Coherence; Triamcinolone Acetonide - administration & dosage; Triamcinolone Acetonide - adverse effects; Vascular Endothelial Growth Factor A - antagonists & inhibitors; Visual Acuity - physiology; Vitreous Body; Choroidal neovascularization; Age-related macular degeneration; Pigment epithelium detachment; Bevacizumab; Triamcinolone acetonide
• ISSN: 0721-832X; 1435-702X
• DOI: 10.1007/s00417-010-1302-4

Purpose
To discuss the effect and outcome of a combined intravitreal triamcinolone acetonide (IVTA) injection with intravitreal bevacizumab (IVB) in treating choroidal neovascularization (CNV) associated with large retinal pigment epithelial detachment (PED) in age-related macular degeneration (AMD).
Design
Prospective, consecutive, observational case series.
Methods
Seven eyes (five patients) with CNV associated with large PED in AMD were treated by IVTA (4 mg/ 0.1 ml), followed by a IVB (1.25 mg/0.05 ml) 1 week later. Patients were evaluated for best-corrected visual acuity (BCVA) and optical coherence tomography (OCT) at baseline, at 1 week and every 6 weeks. Fluorescein angiography (FA) and indocyanine green angiography (ICG) were performed at baseline and every 3 months afterwards. Indications for retreatment by combined injection were defined as persistent PED with subretinal and/or intraretinal fluid on OCT. Patients with flattening of the PED and activity leakage demonstrated by OCT underwent subsequent IVB.
Results
The mean duration of follow-up was 11 months (range 9–14 months). BCVA at baseline averaged 20/125, and 20/80 at the end of follow-up. FA showed no leakage from the lesion in four eyes at the end of follow-up, and three eyes showed a decrease in leakage. Average central foveal thickness was (CFT) 325.7 microns at baseline and 209.2 microns at the end. The average size of the PED was 2.34 disk diameters (range 1.33–3.25) at baseline, and the PED disappeared in four eyes, while it decreased in size at the end in the remaining three. The subretinal fluid disappeared in all patients at the end. The combined treatment (IVTA with IVB 1 week later) was repeated in four eyes, and the number of IVB after combined injection ranged from one to three. No RPE tear appeared during follow-up. Two eyes developed glaucoma controlled by topical medication. There were no other ocular or systemic complications
Conclusion
Combined IVB and IVTA therapy seems to be an effective and safe procedure to treat CNV associated with large PED in AMD.