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M.–N. Delyfer, M.–B. Rougier, E. Fourmaux, J.–F. Korobelnik; Posterior Sub–Tenon’s Injection of Triamcinolone Acetonide in Exudative AMD: Effects on Macular Thickness . Invest. Ophthalmol. Vis. Sci. 2006;47(13):5248.
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In order to reduce the pro–angiogenic effects of PhotoDynamic Therapy (PDT) in exudative Age–related Macular Degeneration (AMD) patients, a combined therapeutic approach using PDT and triamcinolone acetonide has been proposed. Precise time period between triamcinolone intravitreal injection and PDT is a matter of debate and, according to authors, varies from few hours to several weeks. Although uncommon, severe adverse effects (i.e. retinal detachment, endophthalmitis or cataract) are associated with intraocular injection. Conversely, posterior sub–Tenon’s injection, which has been widely used in inflammatory eye diseases, does not entail such risks and could thus represent an interesting alternative to intravitreal injection.
To analyze early modifications of macular thickness induced by posterior sub–Tenon’s injection of triamcinolone acetonide performed one week prior to PDT during the treatment of exudative AMD.
Twenty patients with neovascular AMD requiring Verteporfin PDT received a posterior sub–Tenon’s injection of 40 mg triamcinolone acetonide 7 days before PDT. Optical Coherence Tomography imaging was performed using OCT–3 (Carl Zeiss Meditec, Dublin, CA) just prior posterior sub–Tenon’s injection of triamcinolone and 7 days later just before PDT. Center foveal thickness, average macular thickness and total macular volume were evaluated. Modifications of 20 percent or more were considered to be significant.
Though a trend to a decrease of macular thickness was noticed, the overall results at day 7 were not statistically significant. Some cases of very important decrease in macular thickness were however observed. No complications were encountered.
Posterior sub–Tenon’s triamcinolone injection is well tolerated. The trend to the decrease of macular thickness assesses that triamcinolone acetonide is absorbed by transcleral diffusion 7 days after injection. Our data therefore argue for observing a 7 days’ delay between posterior sub–Tenon’s injection of triamcinolone and Verteporfin PDT in the combined treatment of exudative AMD.
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