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C.N. Singh, D.A. Saperstein; Combination Therapy Using Reduced Fluence Photodynamic Therapy and Intravitreal Kenalog for Choroidal Neovascularization in Macular Degeneration . Invest. Ophthalmol. Vis. Sci. 2006;47(13):2166.
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This case series was designed to evaluate reduced–fluence photodynamic therapy (PDT) with intravitreal triamcinolone acetonide for choroidal neovascularization (CNV) secondary to age–related macular degeneration.
The study was designed as a retrospective consecutive case series of 27 eyes of 26 patients with subfoveal CNV secondary to AMD. There was no restriction to type of CNV. 9 of the eyes were treated with a fluence of 50 J/cm2, 11 with 40 J/cm2, and 7 with 25 J/cm2. PDT was immediately followed by intravitreal injection of 4mg of triamcinolone acetonide (IVK). Patients were followed at 6–week intervals with comprehensive eye exams and fluorescein angiograms when indicated. Retreatment was performed when indicated. All patients had at least 6 months of follow up.
Patients treated with 50 J/cm2 lost a mean of 0.98 lines of best corrected visual acuity at 6 month follow up, compared to 1.09 lines lost in the group treated with 40 J/cm2 and a gain of 0.23 lines in the group treated with 25 J/cm2. Of the group treated with 50 J/cm2, 6 (66.7%) lost less than 3 lines of visual acuity and 3 (33.3%) gained at least 3 lines of visual acuity. 8 (72.7%) of the group treated with 40 J/cm2 lost less than 3 lines of visual acuity, and 2 (18.2%) gained at least 3 lines of visual acuity. Of the group treated with 25 J/cm2, 6 (85.7%) lost less than 3 lines of visual acuity, and 2 (28.6%) gained at least 3 lines of visual acuity. 3 (33.3%) of the patients treated with 50 J/cm2 required retreatment by 6 month follow up. 5 (45.5%) of the patients treated with 40 J/cm2 and 3 (42.9%) of the patients treated with 25 J/cm2 required retreatment by 6 month follow up. 10 eyes (37%), 5 in the 50 J/cm2 group, 2 in the 40 J/cm2 group, and 3 in the 25 J/cm2 group required topical therapy to control intraocular pressure. No patients required surgical control of their IOP. 7 eyes (26.9%) were still on topical therapy at 6–month follow up. 2 out of 15 (13.3%) of phakic eyes required cataract extraction during the follow up period, and both of these eyes had cataracts prior to treatment. There were no incidents of choroidal infarction or endophthalmitis.
In this small case series there is a trend favoring reduced fluence PDT in combination with IVK. Retreatment rates were lower than those reported in the VIP and TAP studies at the 6 month follow–up. Adverse events included elevation of IOP and cataract. Although the sample size of this study is small, the results warrant further investigation of using reduced fluence PDT with IVK.
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