Riazi-Esfahani Mohammad, Ahmadieh Hamid, Faghihi Hooshang, Piri Niloofar, Taei Ramin, Karkhaneh Reza, Alami-Harandi Zahra, Lashay Alireza, Mirshahi Ahmad, Nili-Ahmadabadi Mehdi, Soheilian Masoud, Sanagou Masoumeh
Eye Research Center, Farabi Hospital, Tehran Medical University, Tehran, Iran.
J Ophthalmic Vis Res. 2008 Apr;3(2):95-101.
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).
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.
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).
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.
比较玻璃体内注射贝伐单抗（IVB）与玻璃体内注射贝伐单抗联合曲安奈德（IVB/IVT）治疗新生血管性年龄相关性黄斑变性（AMD）的短期疗效。
对90例继发于AMD的黄斑中心凹下和黄斑中心凹旁脉络膜新生血管（CNV）患者的92只眼进行了这项随机临床试验。将这些眼随机分为单独接受1.25 mg IVB治疗组（53只眼）或联合2 mg IVT治疗组（39只眼）。评估最佳矫正视力（BCVA）和眼底自发荧光，并在基线时进行荧光素血管造影（FA）和光学相干断层扫描（OCT），治疗6周后重复进行。
平均年龄为70.6±8.7（范围50 - 89）岁，57.7%的患者为男性。IVB组BCVA从1.03±0.40 logMAR提高到0.93±0.38 logMAR（P = 0.001），IVB/IVT组从1.08±0.33 logMAR提高到0.91±0.38 logMAR（P = 0.008）。联合治疗有更大视力改善的趋势（P = 0.06）。基线时眼底自发荧光为+1的眼BCVA改善大于+2（P = 0.049）和+3（P < 0.001）的眼。IVB组中心黄斑厚度平均降低113±115 μm（P < 0.001），IVB/IVT组为53.96±125 μm（P = 0.008），组间无差异（P = 0.38）。FA显示IVB组57.4%的患者渗漏减少，12.8%的患者渗漏增加，29.8%的患者无变化。IVB/IVT组相应数字为60.0%、5.7%和34.3%（P = 0.556）。
在贝伐单抗治疗新生血管性AMD时添加曲安奈德似乎并未显著提高其短期疗效。更严重的眼底自发荧光似乎预示着对治疗的反应较差。
