Evaluating the efficacy of anti-VEGF therapy in patients with exudative age-related macular degeneration and concomitant glaucoma

Abstract

AIM: to evaluate the efficacy of anti-VEGF therapy in patients with exudative age-related macular degeneration (AMD) and glaucoma. MATERIAL AND METHODS: The study enrolled 117 patients (117 eyes) with exudative AMD and concomitant non-operated primary open-angle glaucoma (POAG). All patients were divided into several groups depending on their intraocular pressure (IOP) and stage of POAG. Hypotensive therapy included carbonic anhydrase inhibitors, beta-adrenergic antagonists (beta blockers) and alpha(2)-adrenergic agonists (alpha-2 mimetics). Lucentis (ranibizumab) was intravitreally injected thrice at monthly intervals. All patients underwent a standard ophthalmic examination, fluorescent retinal angiography, and optical coherence tomography. IOP was measured before the first and after the last injection by means of Icare PRO reboud tonometer. RESULTS: There was no statistically significant difference between groups Ia, IIa, Ib, and IIb in terms of IOP elevation. Glaucoma IIc and IIIa patients showed just a moderate increase in IOP that did not require regimen adjustment. There was, however, a single IIIb case of persistent IOP elevation, in which one-step penetrating trabeculectomy with intravitreal ranibizumab injection was later performed. Resolution of macular edema was achieved in all patients. Visual acuity (VA) varied between the groups demonstrating a tendency toward improvement in glaucoma Ia patients (p = 0.062) and stabilization in glaucoma IIa (p = 0.61), Ib (p = 0.07), and IIb (p = 0.29) patients. In some cases of low vision at baseline and subretinal fibrosis, VA changes were of no clinical significance. CONCLUSIONS: Intravitreal ranibizumab therapy proved effective in exudative age-related macular degeneration with concomitant glaucoma. Timely treatment of both AMD (i.e. before the development of subretinal fibrosis) and glaucoma contributes to therapeutic success in these patients.