Dorzolamide-timolol Drops With Injections to Treat AMD,RVO or DME.

Intravitreal anti-vascular endothelial growth factor (VEGF) agents, including bevacizumab,
ranibizumab, and aflibercept, have become the gold standard treatment for neovascular
age-related macular degeneration (AMD). Various treatment modalities using these agents have
been proposed, including monthly, pro re nata, and treat-and-extend philosophies. Despite
frequent and consistent treatment with anti-VEGF therapy, there is a subset of patients who
are incomplete or non-responders and have persistent evidence of exudation on spectral-domain
optical coherence tomography (SD-OCT), including subretinal fluid (SRF) and/or intraretinal
edema.

While clearance of intravitreal anti-VEGF drugs is not completely understood, some studies
have suggested that outflow through the anterior chamber may contribute. We hypothesized that
by decreasing aqueous production, outflow may also be reduced which could delay the clearance
of intravitreal drugs. As a result, we chose topical dorzolamide-timolol since it is a potent
aqueous suppressant and is readily available due to its common use in the treatment of
glaucoma. The current study aimed to evaluate the efficacy of topical dorzolamide-timolol on
anatomic and visual outcomes in anti-VEGF non-responders with neovascular AMD.

Significance: The results of this study will help delineate whether topical aqueous
suppression may be useful as adjuvant therapy in patients receiving chronic intravitreal
anti-VEGF injections.

Inclusion Criteria:

1. Patient of Wills Eye Hospital Retina Service and/or Mid Atlantic Retina.

2. Volunteer patients age 18 years and older.

3. Healthy enough to participate in the study.

4. Willing and able to consent to participation in the study.

5. Diagnosis of wet age-related macular degeneration

6. Prior treatment with at least 4 injections of anti-VEGF agents in the past 6 months
and persistent intraretinal and/or subretinal fluid on SD-OCT at each visit during
this period

7. Injection of the same anti-VEGF agent for at least two visits prior to study
enrollment

8. Fixed interval between at least two visits prior to study enrollment

Exclusion Criteria:

1. History of uveitis

2. Any ophthalmic surgery within previous 6 months, including cataract extraction.

3. Any history of vitrectomy

4. History of any glaucoma drop usage or prior glaucoma surgery

5. Systemic diuretic or corticosteroid usage

6. Any contraindication (bradycardia, decompensated heart failure, or reactive

7. airway disease) for topical use of a beta-blocker

8. Any history of sulfonamide allergy