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J. A. Patterson, H. Jayaram, K. Gregory-Evans; Intravitreal Triamcinolone in Macular Fibrovascular Pigment Epithelial Detachment: Use and Role as an Adjunctive Treatment With Photodynamic Therapy. Invest. Ophthalmol. Vis. Sci. 2008;49(13):589.
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To assess the scope and magnitude of the effect of intravitreal Triamcinolone in a series of macular fibrovascular pigment epithelial detachments (PED). Cases where complete flattening of the subretinal component occurred were treated with photodynamic therapy to see if use an adjunctive combination therapy could achieve a long lasting flattening effect than that produced by either therapy alone.
26 consecutive patients with fibrovascular PED presenting to a medical retinal clinic received intravitreal Triamcinolone. Clinical examination including refracted visual acuity, fluorescein angiography and optical coherence tomography were carried at each clinic visit. Further Triamcinolone injections were given if some flattening of the PED occurred. All cases were followed up for a minimum of 12 months after injection.
Reduction of the PED to a variable extent occurred in 90% of patients. The effect was maximal at 10 weeks post injection tailing off after that but persisted in some patients for as long as 6 months. Complete flattening of the subretinal component occurred in 19%. Photodynamic therapy of these cases led to a long lasting flattening which was maintained over a year with no morbidity due to retinal pigment epithelium rip. There were no major injection related complications such as infection or traumatic cataract but almost 50% of cases developed raised intraocular pressure, which in all cases responded to topical therapy.
Most cases of fibrovascular PED treated with intravitreal Triamcinolone will show transient reduction of overall PED height and subretinal fluid. In a subset of cases complete flattening of the subretinal fluid component occurred. Photodynamic therapy in these cases prevented fluid reaccumulation over more than a year of follow-up, with no morbidity due to retinal pigment epithelial rip which has been reported with anti-VEGF treatments, or photodynamic therapy used in isolation. This combined treatment approach may be useful in the treatment of fibrovascular PED and warrants further study.
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