PRESENTATIONS FROM THE RETINA SOCIETY

IVTA to the Rescue?

Triamcinolone tested for ranibizumab failure.

Intravitreal triamcinolone acetonide has been found to be an effective rescue therapy for ranibizumab (Lucentis, Genentech) nonresponders. A poster at the Retina Society meeting in Boston illustrated the findings of this study on the short-term results using triamcinolone acetonide (IVTA) as a rescue therapy when ranibizumab treatment has failed in the treatment of age-related macular degeneration (AMD). Measuring visual acuity (VA) and macular thickness, researchers found that, at least in the short term, IVTA can be an effective adjunct.

STUDY PROTOCOL

The research team, led by Nauman A. Chaudhry, MD, performed a retrospective case series study of 13 eyes in 11 patients who had been treated with 2 rounds of ranibizumab, administered 3 times every 4 weeks. Before administration of IVTA was administered, choroidal neovascularization (CNV) was confirmed using both optical coherence tomography (OCT) and fluorescein angiography (FA). VA was measured using a Snellen chart and slit-lamp biomicroscopy, 90 D ophthalmoscopy, and intraocular pressure (IOP) measurement was performed in all patients.

Patients were then received IVTA 4 weeks after their last ranibizumab injection. Follow-up was carried out at an average of 3 months. The team found a mean VA improvement of 2.2 lines, with 58% of injected eyes improving by 2 lines of more, while 42% remained stable. The mean post- IVTA VA was 20/100, improved from a mean of 20/200 post-ranibizumab but pre-triamcinolone. Further, post- IVTA eyes reduced in macular thickness between 10 and 112 μm, with a mean post-injection OCT measurement of 178 ±60.3 μm and a statistically significant P-value of .002.

NO ENDOPHTHALMITIS

There was no endophthalmitis in the 11 patients in the cohort. However, 28% experienced a rise in IOP of >20 mm Hg. Furthermore, after 3 months, 70% had a recurrence in CNV and required retreatment with ranibizumab.

While unable to make any long-term conclusions about the efficacy of IVTA as a rescue therapy in the event of ranibizumab failure, Chaudhry et al. nevertheless state that IVTA "appears to be effective in improving VA and anatomical configuration of the fovea. They conclude that IVTA might best be used as a coadjuvant therapy with ranibizumab when it has not worked on its own. RP