Purchase this article with an account.
L.A. Alami, C. Gordon, S. Purohit; Choroidal Hypoperfusion Resulting From Combined Intravitreal Triamcinolone Acetonide and Photodynamic Therapy as Treatment for Choriodal Neovascularization Secondary to Age–Related Macular Degeneration . Invest. Ophthalmol. Vis. Sci. 2006;47(13):356.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
There is currently debate as to whether combined photodynamic therapy (PDT) and intravitreal triamcinolone (IVTA) treatment for neovascular age–related macular degeneration alters choroidal perfusion. The present study compares the incidence of choroidal hypoperfusion among patients with subfoveal choroidal neovascularization (CNV) several months after treatment with concurrent PDT and IVTA, IVTA before PDT, and IVTA after PDT.
Retrospective cohort study of 106 patients (106 eyes) with subfoveal CNV with a mean age of 81.7 years receiving PDT and IVTA therapy between January 2004 and October 2005. Patients were divided into three treatment arms: (1) PDT and IVTA on the same day, (2) IVTA within ten days before PDT, and (3) IVTA within ten days after PDT. Patients were treated with an intravitreal injection of 4 mg of triamcinolone, and photodynamic therapy with verteporfin was performed using standard treatment parameters. A fluorescein angiogram was performed on each patient before treatment, and compared to the next fluorescein angiogram 2 to 5 months after treatment to identify patients with choroidal hypoperfusion.
Fluorescein angiograms demonstrated choroidal hypoperfusion in 20.8% of all patients with a treatment group breakdown of 14.5% with IVTA and PDT performed on the same day (n=55), 25.0% with IVTA before PDT (n=24), and 29.6% with IVTA after PDT (n=27). Chi–square analysis failed to show significance (p=0.24).
Our results show that a portion of patients with subfoveal CNV that receive treatment with combined photodynamic therapy and intravitreal triamcinolone may develop choroidal hypoperfusion regardless of the sequence of combined therapy. The lowest incidence of choroidal hypoperfusion was found in patients receiving PDT and IVTA on the same day, although the relationship between treatment sequence and incidence was not statistically significant. A randomized clinical trial is required to confirm the results of choroidal hypoperfusion found in our study.
This PDF is available to Subscribers Only