Effect of Combination of Dorzolamide with Timolol for Wet Age-Related Macular Degeneration
In some eyes with wet age-related macular degeneration (AMD), exudation does not stop despite frequent intravitreal injections of vascular endothelial factor blockers (anti-VEGF). Adjuvant therapy that reduces edema may improve overall treatment outcomes concerning visual functions. A recently published multicenter randomized clinical study evaluated the effect of local therapy combining dorzolamide and timolol in patients with this issue.
Recruitment of probands took place between March 1, 2017, and October 30, 2018. Patients with wet AMD, who continued to experience exudation despite intravitreal applications of anti-VEGF at intervals of 4, 5, or 6 weeks, were included. The aim was to assess the short-term effect of topically administered fixed combination of dorzolamide/timolol versus placebo.
Monitored Parameters
The primary monitored parameter was the change in average central retinal thickness from the initial examination to the third check-up (approximately 3 months). Measurements were made using optical coherence tomography (OCT). Secondary monitored parameters included changes in the height of subretinal fluid, detachment of the retinal pigment epithelium, and average visual acuity.
Evaluated Population and Study Course
The study included 52 patients with an average age of 78.4 years (standard deviation [SD] 7), and 68% were women. The median number of injections patients received before study inclusion was 20.5 (SD 14). The median visual acuity in logMAR at the start of the study was 0.361 (SD 0.26), corresponding to a spherical equivalent of approximately 20/50.
Probandi were randomized to use either dorzolamide/timolol or artificial tears. For the next 3 visits, they also received the same anti-VEGF medication that they had received during the 2 visits before study inclusion.
Results
The primary monitored parameter could be evaluated in all 27 patients (100%) in the active treatment group (dorzolamide/timolol) and in 23 out of 25 (92%) subjects in the placebo group.
The comparison between the dorzolamide/timolol group and the placebo group from the initial to the third examination yielded the following results (standard deviations in parentheses):
- Median change in central retinal thickness (primary monitored parameter) −36.6 (54) vs. 1.7 (52.3) μm (p = 0.04).
- Average height of retinal pigment epithelium detachment −39.1 (65) vs. 1.1 (16) μm (p = 0.01).
- Change in visual acuity −2.3 (5) vs. 0.3 (1) letters (p = 0.78).
Conclusion
The use of dorzolamide/timolol combination in patients with wet AMD and persistent exudation led to anatomical improvement but had no effect on visual acuity. Clinical trials with a longer follow-up period and a larger patient cohort will likely be necessary to verify the potential significance of dorzolamide/timolol in the treatment of wet AMD.
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Source: Hsu J., Patel S. N., Wolfe J. D. et al. Effect of adjuvant topical dorzolamide-timolol vs placebo in neovascular age-related macular degeneration: a randomized clinical trial. JAMA Ophthalmol 2020 Apr 2; 138 (5): 560−567, doi: 10.1001/jamaophthalmol.2020.0724.
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