Combined Intravitreal Triamcinolone Acetonide And Photodynamic Therapy For Choroidal Neovascularization Associated With Pigment Epithelial Detachment Secondary To Age Related Macular Degeneration

Abstract

Purpose: : We performed a prospective study to evaluate effectiveness and benefits of intravitreal triamcinolone acetonide (IVTA) in the treatment of pigment epithelial detachment (PED) caused by choroidal neovascularization (CNV) secondary to age–related macular degeneration (AMD) in patients whom photodynamic therapy (PDT) with verteporfine had been estimated to increase high risk of pigment epithelial breaks.

Methods: : 19 eyes of 19 patients were included in the study. Inclusion criteria were serous macular PED due to CNV in AMD with no prior treatment and absence of glaucoma. To establish the diagnosis all patients had ETDRS visual acuity, stereo fundus examination, fluoresceine and indocyanine green angiography and ocular coherence tomography (OCT) radial lines scans. After appropriate informed consent, patients had an intravitreal injection of 4 mg of triamcinolone acetonide. A preventive topical hypertensive treatment was prescribed in all cases. ETDRS, stereo fundus examination and OCT imaging were performed at 1 and 2 weeks. Patients who had at least 20/200 visual acuity (VA) were treated with PDT

Results: : Mean VA was 20/320 (range counting fingers to 20/80) at inclusion. In 10 cases occult CNV (53%) were diagnosed. 3 of them were associated with subretinal hemorrhage. 4 cases showed minimally classic CNV (21%). In 5 cases a chorioretinal anastomosis (26%) was identified and 2 (11%) were associated with important subretinal hemorrhage. On initial OCT imaging, all cases with occult CNV or chorioretinal anastomosis (79%) were associated with serous neuroretinal detachment. A certain degree of macular edema was found in all cases. Post IVTA OCT results revealed regression of serous neuroretinal detachment in all cases, with significative regression of PED and subretinal hemorrhage. VA had improved in all patients, with a mean gain of 5 letters. This permitted to perform PDT with verteporfine in 17 cases (89.5%) after 2 weeks of follow up.

Conclusions: : The morphological features and short term changes observed in our study suggest that IVTA is a safe and effective method to reduce PED in AMD which consecutively allows PDT. Therefore it should be performed before PDT to decrease the high risk of pigment epithelial breaks. However, further studies are needed to confirm these findings as a first–line treatment.

Keywords: age-related macular degeneration • choroid: neovascularization • photodynamic therapy