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

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.