Hospital of Olhos Santa Luzia, Brazil
Title: Intravitreal bevacizumab combined with infliximab in the treatment of choroidal neovascularization secondary to age-related macular degeneration: Case report series
Luiz Guilherme, is graduated in Medicine from the University of Grande Rio - RJ- Brazil, He did his Ophthalmology residency at the Hospital de Olhos Santa Luzia / Santa Luzia Foundation (Recife - PE - Brazil). He did his fellowship in Retina and Vitreous by Federal University of Goias, after graduating from the Federal University of Goias. He is a member of the Brazilian Council of Ophthalmology (CBO), Brazilian Society of Retina and Vitreous, International Member of the American Academy of Ophthalmology, the American Society of Retina Specialists also he posses the membership of Scientific reviewer of the Brazilian Archives of Ophthalmology, the Expert Board and Scientific reviewer of the International Journal of Ophthalmology. He contributes as author of scientific publications and chapters books of ophthalmology, he is serving as a professor of the Ophthalmology Residency at the Hospital de Olhos Santa Luzia.
Purpose: To evaluate the feasibility of the combined use of bevacizumab (Avastin®) and combined with infliximab (Remicade®) in the treatment of naive choroidal neovascularization (CNV) due to age-related macular degeneration (ARMD) eyes. Methods: Intravitreal injections of bevacizumab combined with infliximab in 6 neovascular ARMD 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 (OCT) and fluorescein angiography (FA) 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 macular thickness. No change was seen in electroretinogram (ERG) 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 improvement in the exudative process of choroidal neovascularization (CNV). One eye had mild persistent sub macular fluid without active choroidal neovascularization, and, intraretinal fluid with observed in the remaining eye due to active choroidal neovascularization. Conclusion: The combined use of bevacizumab with infliximab in eyes with neovascular age-related macular degeneration was effective in reducing leakage and improving the macular thickness. However, it’s not possible to assert that the results were related to synergic effects of the combination therapy .A controlled study with more cases is necessary to precisely define the complication rates; however the dosage and/or association of drugs studied in this research shouldn’t be recommended in clinical practice due to cataract as well as inflammatory reaction.