gms | German Medical Science

Purpose: To investigate suprachoroidal drug delivery with the use of a microcatheter for the treatment of advanced, refractory, exudative age-related macular degeneration (AMD).

Methods: Twenty eyes of 20 patients with choroidal neovascularization (CNV) secondary to advanced, exudative AMD were enrolled in this feasibility study. The inclusion criteria were for eyes that have either failed or were not candidates for conventional treatments (Lucentis^®, Avastin^®, PDT). No exclusions were made for the presence of pigment epithelial detachment (PED), retinal angiomatous proliferation (RAP), or previous vitrectomy. A microcatheter (iTRACK™ 400, iScience Interventional Corporation) was introduced into the suprachoroidal space through a 2 to 3 mm length dissection at the pars plana and advanced posteriorly while visualizing the illuminated tip beneath the retina through the operating microscope. The microcatheter was then used to deliver bevacizumab (Avastin^®) or a combination of bevacizumab and triamcinolone into the suprachoroidal space directly beneath the macula. Patient follow-up was scheduled for 1, 7, 30, 90, 180 and 360 days post-surgery. Eyes were characterized by visual acuity assessment, fundus photography, fluorescein angiography (FA), and optical coherence tomography (OCT) to document retinal appearance and function.

Results: At this interim analysis, study eyes were followed for an average of 90 days postoperative. The microcatheter was able to be advanced in the suprachoroidal space directly to the macula with the exception of one eye with a history of multiple PDT treatments. Sixteen of 20 eyes demonstrated improvement in visual acuity and 19 of 20 eyes demonstrated biological effect by either reduction in leakage by FA or reduction in macular thickness by OCT. No adverse post-surgical complication was observed.

Conclusions: Suprachoroidal drug administration directly adjacent to the choroid in the submacular region may be a potential treatment for advanced, refractory AMD. Administering therapeutic agents to the suprachoroidal space may be desirable to allow for direct drug exposure to the choroid, potentially increasing choroidal drug levels.