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J.–C. Quintyn, L. Mahieu, Jr., A. Mathis, II; Management of Pigment Epithelium Detachment in Age–Related Macular Degeneration by a Combination of Photodynamic Therapy and Intravitreal Injection of Triamcinolone Acetonide on the Same Day . Invest. Ophthalmol. Vis. Sci. 2006;47(13):376.
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To assess the advantages of combined treatment by dynamic phototherapy (DPT) and intravitreal injection (IVT) of Triamcinolone acetonide on the same day for the treatment of pigment epithelium detachment (PED).
This prospective study involved 17 patients and 19 eyes with PED. PDT was administered to each patient according to usual parameters, followed two hours later by intravitreal injection of 4 mg Triamcinolone acetonide performed in the operating theatre. The efficacy of that treatment was assessed by measuring EDTRS visual acuity before and after one and three months and by OCT performance.
Our patient group included 17 patients, 19 eyes, 11 women and 6 men, mean age 77 years. In half of cases, the second eye presented with DMLA. We noted one case of marked post–IVT inflammatory reaction, which was resolved in 24 hours by topical anti–inflammatory treatment. Baseline visual acuity was 38 EDTRS characters and three after treatment. Three patients had their vision improved by more than three lines. In 74% of cases (14 patients), treatment led to total disappearance of PED after one month, with no recurrence. Half of our patients lived more than 60 km away.
There is no recognised treatment for PED. According to the TAP study, PDT alone is ineffective. For some years, Triamcinolone acetonide intravitreal injection has been recommended by several teams as a supplement to PDT to treat various types of neovascularisation. This combination has also been tested in the treatment of PED although no protocol has been clearly established so far. To spare patients return trips to the hospital, sometimes more than 150 km from their home, and thus reduce their costs, we elected to apply this treatment on the same day. Anatomical results were very satisfying as they made low–vision rehabilitation and vision improvement possible. We recommend treating PED by a combination of PDT and IVT injection of Triamcinolone acetonide. In our experience, this combined treatment was efficacious even when administered on the same day.
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