Topical timolol-dorzolamide combined with anti-VEGF could better treat macular edema

Issue: April 25, 2017

PHILADELPHIA – An ongoing study suggests that topical timolol-dorzolamide can reduce central subfield thickness in patients with persistent macular edema when combined with anti-VEGF treatment, a speaker said at the Wills Eye Conference.

Perspective from Jason Hsu, MD

“The purpose of this study was to evaluate the effect of topical timolol-dorzolamide on anatomical and functional outcomes in eyes with macular edema, retinal vein occlusion, who have persistent fluid despite fixed intravitreal treatments with the same drug,” David S. Ehmann, MD, said.

David S. Ehmann

Ten patients who were already receiving regular anti-VEGF treatment, but still had persistent fluid, were enrolled in the study aiming to evaluate whether the topical aqueous suppressant can decrease outflow and delay clearance of the intravitreal drugs.

While results of the study are pending, so far the researchers have seen a significant reduction in mean central subfield thickness and improved vision in patients, Ehmann said, opening the door to the possibility of a larger, multicenter study. – by Rebecca L. Forand

Reference:

Ehmann D. Topical timolol-dorzolamide in combination with intravitreal Anti-VEF for retinal vein occlusion macular edema. Presented at: Wills Eye Conference; March 9-11, 2017; Philadelphia.

Disclosure: Ehmann reports no relevant financial disclosures.

Perspective

Jason Hsu, MD

The concept of using a readily available glaucoma drop, such as dorzolamide-timolol, as an adjunctive therapy to improve outcomes in eyes with persistent edema despite regular, ongoing anti-VEGF injections is exciting. Perhaps the drops are slowing down turnover of intraocular fluid and removal of the anti-VEGF drug, allowing a longer-lasting effect. It gives hope to patients with retinal vein occlusions who have more anti-VEGF-resistant disease as it may help improve outcomes. However, it is important to keep in mind this was a small pilot study with no control group, so further larger studies will be necessary to confirm the observed effect. If future studies do indeed corroborate these results, the addition of topical aqueous suppressants, such as dorzolamide-timolol, may be a great solution for these difficult cases.

Jason Hsu, MD

Wills Eye Hospital, Philadelphia

Disclosures: Hsu reports he has received grant funding from Genentech and Regeneron and is principal investigator for the study.