42. Antiproliferative pharmacologic agents in coinjunction
with 25 g vitrectomy for retinal vasculopathies
William Aldred (Pensacola)
Triamcinolone Acetonide intravitreal injection proved to be a valuable adjunct to the treatment
of choroidal neovascularization in age related macular degeneration , both as an individual
therapy, and when combined with PDT. This innovative approach ushered in a new era and
treatment philosophy for the management of retinal vasculopathy. In this new paradigm, pharmacologic
therapy is given intravitreally, either before, during or after, another invasive treatment
of a VEGF- related retinal vascular disorder.
The development of anti-VEGF antibodies, antibody fragments, and aptomers, has enlarged the
spectrum of available therapy combinations for proliferative and exudative/transudative retinal
vasculopathies. The use of the these agents, with or without triamcinolone acetonide, in conjunction
with vitrectomy in the treatment of the more severe forms of these conditions was the next logical step in this
evolving therapeutic algorithm.
This paper describes the use of intravitreal triamcinolone acetonide with or without bevacizumab preoperatively, intraoperatively,
and postoperatively, in conjunction with 25 gauge vitrectomy for diabetic retinopathy, vein occlusions, and certain
cases of AMD related CNVMs (many of which also had epiretinal membranes). The treatment and prevention of neovascular
glaucoma complicating the first two conditions is also discussed. Additional uses of adjunctive agents, such as intravitreal
injections combined with cataract surgery in high risk patients are also discussed.
This single surgeon series, outlined with didactic slides, OCT’s . FA’s and surgical video clips is designed to assist the surgeon
in developing his own algorithms for the use of the agents adjunctively with vitrectomy. Hopefully, this addition to your
practice pattern will allow for a more simplified operative procedure, with fewer intraoperative and postoperative complications,
and better visual outcomes.