Skip to main content

Advertisement

SpringerLink
Log in

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

  • Retinal Disorders
  • Published:
Graefe's Archive for Clinical and Experimental Ophthalmology Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Slakter JS, Yannuzzi LA, Sorenson JA et al (1994) A pilot study of indocyanine green videoangiography-guided laser photocoagulation treatment of occult choroidal neovascularization in age-related macular degeneration. Arch Ophthalmol 112:465–472

    CAS  PubMed  Google Scholar 

  2. Ladas ID, Kotsolis AI, Rouvas AA et al (2007) Efficacy of photodynamic therapy in the management of occult choroidal neovascularization associated with serous pigment epithelium detachment. Ophthalmologica 221(5):313–319

    Article  CAS  PubMed  Google Scholar 

  3. Augustin AJ, Puls S, Offermann I (2007) Triple therapy for choroidal neovascularization due to age-related macular degeneration: verteporfin PDT, bevacizumab, and dexamethasone. Retina 27(2):133–140

    Article  PubMed  Google Scholar 

  4. Haines JL, Hauser MA, Schmidt S et al (2005) Complement factor H variant increases the risk of age-related macular degeneration. Science 308:419–421

    Article  CAS  PubMed  Google Scholar 

  5. Edwards AO, Ritter R 3rd, Abel KJ, Manning A, Panhuysen C, Farrer LA (2005) Complement factor h polymorphism and age-related macular degeneration. Science 308:421–424

    Article  CAS  PubMed  Google Scholar 

  6. Ruiz Moreno JM, Montero J, Barile S, Zarbin M (2006) Photodynamic therapy and high-dose intravitreal triamcinolone to treat exsudative age-related macular degeneration. 1-year outcome. Retina 26:602–612

    Article  PubMed  Google Scholar 

  7. Ahmadieh H, Taei R, Soheilian M et al (2007) Single-session phototherapy therapy combined with intravitreal bevacizumab and triamcinolone for neovascular age-related macular degeneration. BMC Ophthalmol 7:10

    Article  PubMed  Google Scholar 

  8. Avery RL, Pieramici DJ, Rabena MD et al (2006) Intravitreal bevacizumab (Avastin) for neovascular age-related macular degeneration. Ophthalmology 113:363–372

    Article  PubMed  Google Scholar 

  9. Arevalo JF, Fromow-Guerra J, Sanchez JG, Maia M, Berrocal MH, Wu L, Saravia MJ, Costa RA (2008) Primary intravitreal bevacizumab for subfoveal choroidal neovascularization in age-related macular degeneration: results of the Pan-American Collaborative Retina Study Group at 12 months follow-up. Retina 28(10):1387–1394

    Article  PubMed  Google Scholar 

  10. Meyer CH, Mennel S, Schmidt JC, Kroll P (2006) occult choroidal neovascularisation secondary to intravitreal bevacizumab (Avastin) injection for Acute retinal pigment epithelial tear following age related macular degeneration. Br J Ophthalmol 90(9):1207–1208

    Article  CAS  PubMed  Google Scholar 

  11. Spaide RF (2006) Rationale for combination therapies for choroidal neovascularization. Am J Ophthalmol 141:149–156

    Article  PubMed  Google Scholar 

  12. Ciulla TA, Criswell MH, Danis RP et al (2001) Intravitreal triamcinolone acetonide inhibits choroidal neovascularization in a laser-treated rat model. Arch Ophthalmol 119:399–404

    CAS  PubMed  Google Scholar 

  13. Spaide RF, Sorenson J, Maranan L (2005) Photodynamic therapy with verteporfin combined with intravitreal injection of triamcinolone acetonide for choroidal neovascularization. Ophthalmology 112:301–304

    Article  PubMed  Google Scholar 

  14. Spaide RF, Sorenson J, Maranan L (2003) Combined photodynamic therapy with verteporfin and intravitreal triamcinolone acetonide for choroidal neovascularization. Ophthalmology 110:1517–1525

    Article  PubMed  Google Scholar 

  15. Kvanta A, Algvere PV, Berglin L et al (1996) Subfoveal fibrovascular membranes in agerelated macular degeneration express vascular endothelial growth factor. Invest Ophthalmol Vis Sci 37:1929–1934

    CAS  PubMed  Google Scholar 

  16. Hori Y, Hu DE, Yasui K et al (1996) Differential effects of angiostatic steroids and dexamethasone on angiogenesis and cytokine levels in rat sponge implants. Br J Pharmacol 118:1584–1591

    CAS  PubMed  Google Scholar 

  17. Wilson CA, Berkowitz BA, Sato Y et al (1992) Treatment with intravitreal steroid reduces blood–retinal barrier breakdown due to retinal photocoagulation. Arch Ophthalmol 110:1155–1159

    CAS  PubMed  Google Scholar 

  18. Hori Y, Hu DE, Yasui K et al (1996) Differential effects of angiostatic steroids and dexamethasone on angiogenesis and cytokine levels in rat sponge implants. Br J Pharmacol 118:1584–1591

    CAS  PubMed  Google Scholar 

  19. Perretti M, Ahluwalia A (2000) The microcirculation and inflammation: site of action for glucocorticoids. Microcirculation 7:147–161

    CAS  PubMed  Google Scholar 

  20. Scholes GN, O’Brien WJ, Abrams GW et al (1985) Clearance of triamcinolone from vitreous. Arch Ophthalmol 103:1567–1569

    CAS  PubMed  Google Scholar 

  21. Ladas ID, Kotsolis AI, Papakostas TD, Rouvas AA, Karagiannis DA, Vergados I (2007) Intravitreal bevacizumab combined with photodynamic therapy for the treatment of occult choroidal neovascularization associated with serous pigment epithelium detachment in age-related macular degeneration. Retina 27(7):891–896

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department B of Ophthalmology, Hedi Rais Institute of Ophthalmology, Boulevard 9 avril 1006 Bab saadoun, Tunis, Tunisia

    Leila el Matri, Ahmed Chebil, Fadra Kort, Rym Bouraoui, Karim Baklouti & Fatma Mghaieth

Authors
  1. Leila el Matri
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ahmed Chebil
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Fadra Kort
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Rym Bouraoui
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Karim Baklouti
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Fatma Mghaieth
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Leila el Matri.

Additional information

No proprietary interest, no grants and funds received, no financial support

Rights and permissions

Reprints and permissions

About this article

Cite this article

el Matri, L., Chebil, A., Kort, F. et al. Intravitreal injection of triamcinolone combined with bevacizumab for choroidal neovascularization associated with large retinal pigment epithelial detachment in age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol 248, 779–784 (2010). https://doi.org/10.1007/s00417-010-1302-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00417-010-1302-4

Keywords

Search

Navigation