Intravitreal Bevacizumab Combined With Intravitreal Triamcinolone for Therapy-Resistant Exudative Age-Related Macular Degeneration

Purpose: To investigate the effect of intravitreal bevacizumab (IVB) combined with intravitreal high-dose triamcinolone acetonide (IVTA) for therapy of exudative age-related macular degeneration (AMD) after unsuccessful IVB monotherapy. Methods: The prospective study included 29 White patients (31 eyes) who consecutively received IVB (1.5 mg) plus high-dose IVTA (20-25 mg) for exudative AMD, after they had received multiple IVB mono-injections without functional and anatomical success. Two additional IVB injections were given in intervals of 2 months after the combined injection. The main outcome parameters were best-corrected visual acuity (BCVA) and data measured by optic coherence tomography (OCT). Results: Mean BCVA (LogMAR) improved from 0.70 +/- 0.37 LogMAR at baseline to 0.59 +/- 0.38 LogMAR at 2 months after first follow-up (P = 0.004) and to 0.63 +/- 0.41 LogMAR (P = 0.04) at 4 months after baseline. It deteriorated to 0.68 +/- 0.41 at the end of the follow-up at 7 months after the combined injection, without a significant (P = 0.53) difference to the baseline visual acuity. The maximum macular thickness decreased significantly from 371 +/- 206 mu m at baseline to 322 +/- 90 mu m (P = 0.04) at the first follow-up and to 316 +/- 90 mu m (P = 0.03) at the second follow-up. It slightly increased toward the end of follow-up (333 +/- 133 mu m; P = 0.16). Intraocular pressure increased marginally significantly (P = 0.06) from 14.5 +/- 2.8 mm Hg to 15.7 +/- 3.3 mm Hg at the second follow-up. Conclusions: Patients with exudative AMD, in whom monotherapy with IVB was unsuccessful, may experience a temporary improvement in vision and reduction in macular thickness after a combined intravitreal injection of bevacizumab and triamcinolone.