Combined photodynamic therapy and intravitreal triamcinolone injection for the treatment of subfoveal choroidal neovascularisation in age related macular degeneration: a comparative study

• Published in: British journal of ophthalmology Vol. 90; no. 3; pp. 337 - 341
• Main Authors: Chan, W-M, Lai, T Y Y, Wong, A L, Tong, J-P, Liu, D T L, Lam, D S C
• Format: Journal Article
• Language: English
• Published: BMA House, Tavistock Square, London, WC1H 9JR BMJ Publishing Group Ltd 01.03.2006; BMJ; BMJ Publishing Group LTD; BMJ Group
• Subjects: age related macular degeneration; Aged; Aged, 80 and over; AMD; Angiogenesis; BCVA; best corrected visual acuity; Biological and medical sciences; Cell adhesion & migration; choroidal neovascularisation; Choroidal Neovascularization - drug therapy; Choroidal Neovascularization - etiology; Choroidal Neovascularization - physiopathology; Clinical Science - Extended Report; CNV; Combined Modality Therapy; Disease Progression; Diseases of the skin. Cosmetics; Female; fluorescein angiography; Glaucoma; Glucocorticoids - therapeutic use; Humans; intraocular pressure; intravitreal triamcinolone; IOP; IVTA; Macular degeneration; Macular Degeneration - complications; Macular Degeneration - drug therapy; Macular Degeneration - physiopathology; Male; Medical imaging; Medical sciences; Miscellaneous; Occult sciences; Ophthalmology; PDT; Photochemotherapy - methods; Photodynamic therapy; Photosensitizing Agents - therapeutic use; Porphyrins - therapeutic use; Prospective Studies; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); retinal pigment epithelium; RPE; Studies; Treatment Outcome; Triamcinolone - therapeutic use; vascular endothelial growth factor; VEGF; Vision Disorders - etiology; Vision Disorders - prevention & control; Visual Acuity - drug effects; Corticosteroid; Photodynamic therapy; Antiinflammatory agent; Choroid; Vitreous body; Injection; Macular degeneration; Adrenal hormone; Combined treatment; Neovascularization; Ophthalmology; Triamcinolone; Comparative study
• ISSN: 0007-1161; 1468-2079
• DOI: 10.1136/bjo.2005.081299

Aim: To evaluate the outcomes of combined intravitreal triamcinolone (IVTA) and photodynamic therapy (PDT) with verteporfin in the treatment of subfoveal choroidal neovascularisation (CNV) caused by age related macular degeneration (AMD). Methods: 48 eyes from 48 patients with subfoveal CNV caused by AMD were prospective recruited, with 24 eyes treated with combined PDT with IVTA and compared with a control group of 24 eyes which received PDT monotherapy. In the combined treatment group, IVTA was performed immediately after PDT as an outpatient procedure. The mean number of treatments, mean logMAR best corrected visual acuity (BCVA), mean line of visual acuity changes, and proportion of patients without moderate visual loss at 1 year were compared between the combined and monotherapy groups. Results: At 1 year the logMAR BCVA for the PDT with IVTA group changed from 0.88 to 0.95 (p = 0.32 compared with baseline), whereas the logMAR BCVA for the monotherapy group reduced from 0.74 to 1.09 (p<0.001 compared with baseline). A significantly higher proportion of patients who had PDT with IVTA did not develop moderate visual loss at 1 year compared with the monotherapy group (70.8% and 33.3% respectively, p = 0.009). Eyes which had combined treatment had significantly fewer lines lost compared with monotherapy alone (0.7 and 3.5 lines respectively, p = 0.015). Subgroup analysis showed that PDT with IVTA is effective in preventing visual loss in both predominately classic and occult CNV groups. The mean number of treatments for the combined and monotherapy groups was 1.5 and 1.96 respectively (p = 0.076). Conclusions: Combined PDT with IVTA appeared more effective statistically at 12 months for stabilisation of vision (<3 logMAR lines change) compared with PDT monotherapy. Further randomised control trials might be justified to conclude the efficacy of PDT with IVTA.