Intravitreal bevacizumab combined with infliximab in the treatment of choroidal neovascularization secondary to age-related macular degeneration: case report series
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Data
2013
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Resumo
Purpose: To evaluate the feasibility of the combined use of bevacizumab (Avastin ® )
and combined with infliximab (Remicade ® ) in the treatment of naive choroidal
neovascularization due to age-related macular degeneration eyes.
Methods: Intravitreal injections of bevacizumab combined with infliximab in
6 neovascular age-related macular degeneration eyes. All patients underwent
complete ophthalmologic examination on the initial visit and at days 1, 30, 60,
90, 120, 150 and 180 following the first injection. Optical coherence tomography
and fluorescein angiography were performed during at initial visit and monthly
during the 6 months follow-up period. Electroretinography was performed before
and 30 days after initial injection, in order to evaluate retinal toxicity induced by
such treatment.
Results: Thirty days after the first injection, 5 eyes (83%) shown decrease in ma-
cular thickness. No change was seen in electroretinogram in any eyes compared
to initially performed electroretinogram. All phakic eyes developed cataract. One
patient developed vitritis and was submitted to medical treatment successfully.
At the end of the 6 months follow-up period, 4 patients showed significant im-
provement in the exudative process of choroidal neovascularization. One eye had
mild persistent submacular fluid without active choroidal neovascularization, and
another eye had persistent amount of intraretinal fluid due to active choroidal
neovascularization.
Conclusion: The combined use of bevacizumab with infliximab in eyes with neo
vascular age-related macular degeneration was effective in reducing leakage
and improving the macular thickness. However, it is not possible to assert that
the results were related to synergic effects of the combination therapy. A con-
trolled study with more cases is necessary to precisely define the complicat ion
rates; however the dosage and/or association of drugs studied in this research
should not be recommended in clinical practice due to cataract as well as in
flamm atory reaction.
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Palavras-chave
Retina, Macular degeneration/complications, Choroidal neovascula- rization/etiology, Intravitreal injections, Optical coherence tomography, Angio- genesis inhibitors/therapeutic use, Retina, Degeneração macular/complications, Neovascularização retiniana/etiologia, Injeções intravítreas, Tomografia de coerência óptica, Inibidores da angiogênese/uso terapêutico
Citação
FREITAS, Luiz Guilherme Azevedo de et al. Intravitreal bevacizumab combined with infliximab in the treatment of choroidal neovascularization secondary to age-related macular degeneration: case report series. Arquivos Brasileiros de Oftalmologia, Rio de Janeiro, v. 76, n. 3, p. 180-184, 2013.