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T. Adewoyin, E.C. Fletcher, N.H. V. Chong; Posterior Juxtascleral Triamcinolone as an Adjunct to Photodynamic Therapy . Invest. Ophthalmol. Vis. Sci. 2006;47(13):3246.
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Photodynamic therapy (PDT) is the standard treatment of subfoveal choroidal neovascularisation. However, repeat treatments are common. In recent years, many investigational studies have identified triamcinolone due to its anti–angiogenic and anti–inflammatory properties as a possible adjunctive therapy to PDT. Administration in most of these studies has been intravitreally.This has the attendant risk of cataract, raised intraocular pressure and endophthalmitis.
To compare 80mg triamcinolone delivered posterior juxtascleral as an adjunct to PDT in the treatment of CNV secondary to age related macular degeneration to PDT alone.
Comparative consecutive case series analysis. Control group had PDT therapy only according to TAP guidelines. Combined group had PDT in addition to 80mg posterior juxtascleral triamcinolone. Patients were reviewed every three months with fluorescein angiogram. Primary outcome measure is change in greatest linear dimension; secondary outcome measure is change in visual acuity
There were 40 patients in PDT with TA (combined) group and 63 patients in PDT only (control) group. At three months, there was no significant increase in GLD in the combined group (mean increase = 75mm, p = 0.78) compared to the control group (mean increase = 457.9mm, p = 0.006). Mean number of letters lost in the combined group was 1.38 (p=0.112) compared to 9.07 (p=0.002) in the control group. No adverse reactions were noted in the combined group.
Posterior juxtascleral triamcinolone as an adjuctive therapy to PDT is effective in retarding an increase in lesion size compared to PDT alone, as well as reducing the loss of vision experienced. It is a well tolerated mode of administration. The limitation of this study is that it is a comparative case series. On the basis of this study a randomized controlled study is underway.
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