Abstract
Purpose: :
To examine the effects of diclofenac as an adjunctive treatment to photodynamic therapy (PDT) with verteporfin for choroidal neovascularisation (CNV) in age–related macular degeneration (AMD). Seventy eyes of 58 patients with CNV and DEP and/or DSR and/or OMC (group1), 26 with CNV and frequent recidives (group2), 10 with CNV and DEP, DSR and chorioretinal anastomosis (group3).
Methods: :
All patients were treated with Diclofenac 100LP, by oral way, 1 time a day, associated with Diclofenac–drops 6 times a day, 10 days before PDT, Diclofenac 75LP by oral way, 1time a day, associated with Diclofenac–drops, 3 times a day, the month following PDT. The first exam, and all exams at 3–months follow–up intervals had visual acuity, ocular fundus exam, fluorescein and ICG angiographies and OCT.
Results: :
Ten eyes have improved visual acuity, 45 have the same, no–one lost. Fluorescein leakage disappeared in 45 cases, 10 cases kept a mild staining. Thirty–five CNV have low flow, and 20mild flow at ICG. OCT pointed out that OMC disappeared in 25 cases, was 75% reduced in 10 cases, DSR disappeared in 40 cases, was 75% reduced in 15 cases, DEP was reduced in thickness, length, surface and have more regular limits in all cases. The best results were obtained with group1, then with group2, the worse with group3. Diclofenac was in most cases well tolerated, 5 patients have had PDT alone.
Conclusions: :
The results, with generally improved or equal visual acuity, the lack of fluorescein leakage, low flow CNV in ICG, reduction of exudation on OCT, suggest adjunctive Diclofenac treatment to PDT seems effective, almost interesting as Triamcinolone Acetonide, and allow to avoid the risks of bad side effects of intravitreal injection and corticosteroids.
Keywords: photodynamic therapy • neovascularization • age-related macular degeneration