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INTRAVITREAL BEVACIZUMAB VERSUS COMBINED INTRAVITREAL BEVACIZUMAB AND TRIAMCINOLONE FOR NEOVASCULAR AGE-RELATED MACULAR DEGENERATION: Six-Month Results of a Randomized Clinical Trial

Ahmadieh, Hamid MD*; Taei, Ramin MD*; Riazi-Esfahani, Mohammad MD; Piri, Niloufar MD; Homayouni, Mansour MD*; Daftarian, Narsis MD*; Yaseri, Mehdi MSc*

doi: 10.1097/IAE.0b013e31820d58f2
Original Study
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Purpose: To determine whether combined intravitreal bevacizumab (IVB) and triamcinolone (IVT) is more effective than IVB alone in neovascular age-related macular degeneration.

Methods: This was a prospective, randomized clinical trial performed at two centers. Eligible eyes were assigned randomly to one of the two study arms. In the IVB group, 3 consecutive injections of 1.25 mg of bevacizumab were given 6 weeks apart, while in the IVB/IVT group, the first of the triple IVB injections was combined with 2 mg of IVB. A fourth IVB was injected in eyes demonstrating active choroidal neovascularization at Week 24.

Results: Sixty and 55 eyes were in the IVB and IVB/IVT groups, respectively. Best-corrected visual acuity improved, and central macular thickness was reduced significantly in both groups at all time points. Visual improvement was more pronounced in the IVB/IVT group compared with the IVB group 6 weeks (8.5 ± 14.4 vs. 3.8 ± 8.9 letters, P = 0.04) and 12 weeks (11.8 ± 16.6 vs. 6.2 ± 10.8 letters, P = 0.03) after initiation of therapy. However, there was no significant difference in visual improvement at Week 24 (11.3 ± 17.2 letters in the IVB/IVT group vs. 8.7 ± 15.6 letters in the IVB group, P = 0.40). The IVB/IVT group showed significantly less need for a fourth injection at Week 24 (34.5% vs. 53.3% in the IVB/IVT and IVB groups, respectively, P = 0.04).

Conclusion: Mandated therapy with IVB improved best-corrected visual acuity and decreased central macular thickness in neovascular age-related macular degeneration. The addition of low-dose IVT temporarily increased the therapeutic efficacy in the early postinjection period and resulted in fewer requirements for repeat IVB injections at 6 months; however, final levels of visual improvement were comparable in the 2 study groups.

A randomized clinical trial revealed that 3 consecutive intravitreal bevacizumab injections combined with low-dose intravitreal triamcinolone in the first injection compared with 3 consecutive injections of intravitreal bevacizumab alone had modestly superior short-term visual outcomes and resulted in less need for retreatment after 24 weeks in neovascular age-related macular degeneration. However, there was no significant difference between the 2 groups in terms of visual improvement at Week 24.

From the *Ophthalmic Research Center, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; and †Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.

The authors have no financial interest or conflicts of interest.

Reprint requests: Hamid Ahmadieh, MD, Ophthalmic Research Center, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Pasdaran Avenue, Boostan 9 Street, Tehran 16666, Iran; e-mail: hahmadieh@hotmail.com

© The Ophthalmic Communications Society, Inc.