Abstract

SO.11.06

Comparing intravitreal bevacizumab (Avastin^®) and Verteporfin therapy plus intravitreal triamcinolone for neovascular age-related macular degeneration: 6 months results

Michels S., Weigert G., Sacu S., Varga A., Geitzenauer W., Prager F., Schmidt-Erfurth U.
Department of Ophthalmology, Medical University of Vienna, Vienna, Austria

Objective: To compare functional and anatomic outcomes of intravitreal bevacizumab (Avastin^®) and verteporfin therapy combined with intravitreal triamcinolone in patients with neovascular age-related macular degeneration (AMD).
Methods: Twenty-eight patients with neovascular AMD were enrolled in a prospective, randomized, controlled clinical trial. The protocol was approved by the ethics committee at the Medical University Vienna. All patients randomized to 1mg of intravitreal bevacizumab (0.04ml) received 3 initial treatments at 4 weeks intervals. In further follow-up retreatment was based on optical coherence tomography (OCT). Patients randomized to standard verteporfin therapy received a same day intravitreal injection of 4 mg triamcinolone (Kenalog^®). Retreatment was based on fluorescein angiography (FA) at 3 months intervals. Functional and anatomic results were evaluated using the Early Treatment Diabetic Retinopathy Study (ETDRS) protocol vision charts, FA and OCT.
Results: At month 3 visual acuity (ETDRS) increased in the bevacizumab group from 49.6 letters (~20/100) at baseline to 58.8 letters (~20/63) and decreased slightly in the verteporfin and intravitreal triamcinolone treated group from 40.5 (~20/160) to 38.6 (~20/160-1) letters. At 6 months follow-up visual outcomes improved further in the bevacizumab treated group to 64.4 letters (~20/50-1) and decreased further to 33.3 letters (~20/200-2) in the combination therapy group. Starting at one week follow-up visual acuity results were statistically different between both groups. In contrast, both groups showed similar results with regard to reduction in central retinal thickness (CRT) as measured by OCT. CRT was reduced in the bevacizumab treated group from 358µm at baseline to 225µm at month 3 to 242µm at month 6 In the verteporfin and intravitreal triamcinolone treated group CRT regressed accordingly from 328µm to 213µm and to 226µm.
Conclusions: Intravitreal bevacizumab showed promising short-term results in patients with neovascular AMD. Functional results appear not only to be dependent on reduction in CRT but also on the treatment modality used.

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