Journal d'ophtalmologie clinique et expérimentale
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Efficacy and Safety of Combined Intravitreal Bevacizumab and Retrobulbar Corticosteroids for Neovascular Age-Related Macular Degeneration

Raffaele Nuzzi and Laura Dallorto

Introduction: Inflammation plays an important role in age-related macular degeneration (AMD) pathogenesis and progression. Thus, corticosteroids have been used for macular edema associated with exudative AMD. The purpose of this study was to evaluate the efficacy and safety of combined therapy of Intravitreal Bevacizumab (IVB) with Retrobulbar (RB) injection of triamcinolone or dexamethasone (RBTA or RBDEX) in eyes with Choroidal Neovascularization (CNV) in AMD. Secondary, we compared the results with the efficacy of single intravitreal injection of bevacizumab, ranibizumab and aflibercept.
Methods: In this retrospective interventional comparative case series, patients with CNV were treated with IVB (1.25 mg) and RBTA or RBDEX. Control groups included patients who underwent IV injection of Bevacizumab (IVB), Ranibizumab (IVR) and Aflibercept (IVA). The primary purpose was the change of Central Retinal Thickness (CRT) at the Optical Coherence Tomography (OCT) and of Best Corrected Visual Acuity (BCVA) at 1 year.
Results: A total of 123 eyes were divided into Group 1 (31 eyes treated with IVB+RBTA); Group 2 (31 IVB +RBDEX); Group 3 (25 IVB), Group 4 (24 IVA); Group 5, (12 IVR). All 5 groups showed a statistically significant improvement at 1 year in terms of visual acuity and CRT reduction. Group 1 showed significant greater gain of letter at 1-year (13.06 letters) compared to group 3 (8.24 letters, p=0.04) and to group 5 (6.58 letters, p=0.045). Combined therapy showed statistically significantly greater CRT reduction compared to the IVB (mean CRT reduction at 1-year: 71.39 μm, 75.84 μm and 38.44 μm in group 1, 2 and 3) with a lower number of injections per year.
Conclusions: In AMD patients, combined therapy (IVB+RBTA or RBDEX) improved visual acuity with a minimum number of treatments during the 1-year follow-up. Prospective studies with a larger sample are needed to confirm these results and determine the long-term efficacy of this therapy.