Intravitreal Bevacizumab Versus Combined Bevacizumab and Triamcinolone Acetonide for Neovascular Age-Related Macular Degeneration

Purpose: To compare the short-term outcomes of intravitreal bevacizumab (IVB) with the combination of IVB and intravitreal triamcinolone acetonide (IVB/IVT) for treatment of neovascular age-related macular degeneration (AMD).

Methods: This randomized clinical trial was performed on 92 eyes of 90 patients with subfoveal and juxtafoveal choroidal neovascularization (CNV) secondary to AMD. The eyes were randomly assigned to receive IVB 1.25 mg alone (53 eyes) or in combination with IVT 2 mg (39 eyes). Best-corrected visual acuity (BCVA) and fundus autofluorescence were assessed, and fluorescein angiography (FA) and optical coherence tomography (OCT) were performed at baseline and repeated 6 weeks after treatment.

Results: Mean age was 70.6±8.7 (range 50-89) years and 57.7% of the patients were male. BCVA improved from 1.03±0.40 to 0.93±0.38 logMAR (P=0.001) in the IVB group and from 1.08±0.33 to 0.91±0.38 logMAR (P=0.008) in the IVB/IVT group. There was a trend toward greater visual improvement with combined therapy (P=0.06). BCVA improvement was greater in eyes with +1 versus those with +2 (P=0.049) and +3 (P<0.001) fundus autofluorescence at baseline. Mean decrease in central macular thickness was 113±115 μm (P<0.001) in the IVB group versus 53.96±125 μm (P=0.008) in the IVB/IVT group with no intergroup difference (P=0.38). FA showed decreased leakage in 57.4%, increased leakage in 12.8% and no change in 29.8% of patients in the IVB group. Corresponding figures were 60.0%, 5.7% and 34.3% in the IVB/IVT group (P=0.556).

Conclusion: Addition of triamcinolone acetonide to bevacizumab for treatment of neovascular AMD does not seem to significantly increase its short-term efficacy. More severe fundus autofluorescence appears to be predictive of poorer response to treatment.