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M. J. Potter, S. M. Szabo; Incidence of Recurrence of Choroidal Neovascular Membranes at 18 Months After Photodynamic Therapy With Intravitreal Kenalog in Patients With Age-Related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2007;48(13):1783.
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To determine the incidence of recurrence of choroidal neovascular membranes (CNV) at 18 months after treatment with photodynamic therapy (PDT) with verteporfin and intravitreal triamcinolone (Kenalog) in patients with age-related macular degeneration.
This is a prospective study of consecutive patients treated with PDT with intravitreal Kenalog starting between January 2004 and July 2005. Potential patients were limited to those that lived in our metropolitan area, who had cessation of leakage on fluorescein angiography at the end of their treatment course with PDT for CNV in AMD. PDT and intravitreal Kenalog treatment schedules were performed according to the Spaide protocol, with standardized ETDRS acuity measurements recorded at each visit treatment visit. All clinic patients who did not require treatment for 3 consecutive visits (9 months) were discharged to their referring eye doctor, according to standard clinic protocol, and considered a treatment success. Study visits consisted of an ETDRS visual acuity (VA) measurement and fluorescein angiogram, performed 18 months after the final PDT treatment. All photographs and visual acuity measurements were reviewed and compared to 18 months previous data, in a masked fashion, to determine if there had been a recurrence. Incidence of CNV recurrence for the study group was then calculated. Baseline VA, final PDT treatment VA, study visit VA, baseline lesion size and composition, and the number of treatments per patient were compared between those that recurred and did not recur, by t test.
Sixteen patients were identified as study candidates, 14 of whom were willing to participate (87.5%). Mean baseline acuity was 61 letters (20/64+1). An average of 2.1 DPT treatments, and 1.5 Kenalog injections, were administered per patient. Recurrences were observed in 8 of the 14 eyes followed to date (57%) over an 18-month period of follow up. Only final PDT treatment visual acuity was significantly different between those that recurred (53.4 letters; 20/80-1) and those that did not (70.3; 20/40; p=0.38).
CNV recurrences are relatively common in patients treated with PDT with intravitreal Kenalog for CNV in AMD, within 1.5 years of follow up. Retinal specialists should consider the possibility of recurrence when planning patient follow up.
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