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M.S. Dhalla, G.K. Shah, A. Patel, K.J. Blinder, A. Tewari; Photodynamic Therapy With Verteporfin Combined With Posterior Juxtascleral Triamcinolone Acetonide for Choroidal Neovascularization . Invest. Ophthalmol. Vis. Sci. 2006;47(13):372.
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To examine the 6–month results of a group of patients treated with combined photodynamic therapy (PDT) with verteporfin and posterior juxtascleral triamcinolone acetonide for occult and classic choroidal neovascularization (CNV) secondary to age–related macular degeneration (AMD).
This is a retrospective case series involving eighteen eyes of eighteen consecutive patients with CNV secondary to AMD. Fifteen patients with CNV had no prior treatment. Three patients had been previously treatment with a single treatment of PDT alone and demonstrated persistent leakage by flourescein angiography. Patients with CNV had been treated with PDT and 40mg of posterior juxtascleral triamcinolone acetonide at the time of diagnosis. Retreatment was based upon persistent leakage on flourescein angiography at follow up. Main outcome measures were visual acuity and retreatment rate.
Overall mean visual acuity was stabilized with no statistically significant change in visual acuity. In patients with no previous treatment, visual loss was stabilized with a loss of 0.4 lines (P=0.59). In patients with one previous treatment of PDT, mean visual acuity improved by 2.0 lines (P= 0.05). Ten (55.6%) patients required no further treatment. The mean number of retreatments was 0.56 overall, 0.6 in the no prior treatment group, and 0.33 in the previously treated group. One patient (5%), who required two retreatments, developed an intraocular pressure of >24mmHg which responded to monodrop therapy.
Although sample size is limited, reduced re–treatment rates and stabilization of visual acuity suggest that posterior juxtascleral triamcinolone combined with PDT should be examined further in a larger, randomized trial. A more favorable safety profile, including reduced incidence of ocular hypertension when compared to intravitreal triamcinolone delivery, appears to be a distinct advantage of this protocol.
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