Bevacizumab and Triamcinolone Acetonide for Choroidal Neovascularization Due to Age-Related Macular Degeneration Unresponsive to Antivascular Endothelial Growth Factors

Abstract

To evaluate the safety and efficacy of a combined approach using an antivascular endothelial growth factor (VEGF) agent (bevacizumab) and a steroid (triamcinolone acetonide) for treating choroidal neovascularization (CNV) due to age-related macular degeneration (AMD) unresponsive to anti-VEGF monotherapy. Retrospective case series. We analyzed 25 eyes with CNV due to AMD who received a combination of intravitreal bevacizumab (1 mg) and triamcinolone (4 mg). Results were assessed at 7 days, 1, 3, 6, 9, and 12 months by best-corrected visual acuity (BCVA) measurement, fluorescein angiography, indocyanine green angiography, and optical coherence tomography (OCT). Retreatment with intravitreal bevacizumab or combination therapy was considered at investigator discretion at every follow-up visit. A mean BCVA improvement of 0.18 (95% CI: 0.05; 0.3) logMAR was reported between baseline and the 12-month measurement (P<0.01). An opposite trend toward progressive loss of BCVA, from 1.08 to 1.31 logMAR, had been observed in the 6 months before starting the combination therapy, in spite of regular treatment with anti-VEGFs (P<0.0001). OCT measurements showed a 139-μm (95% CI: 76; 203) decrease in mean central retinal thickness (P<0.01). On average, patients required 1.8 additional treatments. Five (20%) cases of intraocular pressure elevation were successfully treated with medications. Combination therapy with intravitreal bevacizumab and triamcinolone acetonide proved to be a safe and effective option for CNV unresponsive to anti-VEGF monotherapy. The combined treatment reversed the preoperative trend toward losing vision, and a significant anatomic improvement was seen by OCT.