Slawomir Cisiecki (Lodz, Poland), Maciej Bednarski (Lodz, Poland), Michael Koss (Frankfurt am Main, Germany), Janusz Michalewski (Lodz, Poland)

Advantages:

The aim of combined treatment in cases of exudative ARMD is to reduce the rate of anti-VEGF injections. Core vitrectomy using intrector is indicated when there is no response after three monthly intravitreal bevacizumab 1.25 mg injections, or if SOCT evaluation shows no evidence of a completely detached hyaloid.

Methods:

26 eyes of 25 patients with a diagnosis of CNV secondary to AMD were included, between January 2008 and December 2008. Patients underwent core vitrectomy using Intrector, with intravitreal injection of 1.25 mg bevacizumab.  Early Treatment Diabetic Retinopathy Study best-corrected visual acuity (BCVA), foveal center thickness (FCT) on spectral optical coherence tomography (SOCT), and fluorescein angiographic findings were examined before and after treatment. Patients were followed up to 12 months.

Effectiveness / Safety:

Complete vitreous detachment in SOCT was identified in 3 eyes. Four eyes that had CNV closure experienced recurrence at 12-months follow-up. In 22 eyes there was on OCT evidence of CNV progression thoughout follow up. No ocular or systemic adverse events from treatment were encountered. Further studies will be needed to better determine long-term efficacy, safety and to evaluate more precisely the role of vitreous liquefaction or detachment in the pathogenesis of AMD.

Take home message:

Combined core vitrectomy – vitreous liquefaction and anti-VEGF treatment can reduce the rate of injections in cases of exudative ARMD.