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T.K. Fackler, M.J. Cooney, S. Fekrat; Retrospective Review of Eyes With Neovascular Age–Related Macular Degeneration Treated With Combined Photodynamic Therapy With Verteporfin and Intravitreal Triamcinolone . Invest. Ophthalmol. Vis. Sci. 2005;46(13):320.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: To review the outcomes of eyes with neovascular age–related macular degeneration treated with combined photodynamic therapy with verteporfin (PDT) and intravitreal triamcinolone acetonide injection (IVK). Methods: We retrospectively reviewed the the charts of all neovascular AMD patients who received IVK within 1 week of their first PDT, and had at least 6 months of follow up. Visual acuity, IOP, SLE, OCT, and fluorescein angiography were done at baseline, 3 months, and 6 months. Greatest Linear Diameter (GLD), Foveal Thickness (FT), and Total Macular Volume (TMV) by OCT were recorded. Patients received additional PDT or combined PDT/IVK treatments at the 3 month or 6 month visit at the discretion of the treating ophthalmologist if angiographic leakage was present. Complications were noted. The Wilcoxon signed ranks test was used to assess significance of change from baseline. Results: Ten eyes from 9 patients were identified that met our study criteria. The mean age was 79.4 (SD 5.5) and 7 were female. Five eyes had predominantly classic CNV lesions, and 5 had minimally classic or occult lesions. All eyes received an initial PDT with IVK. Within the study period, 2 eyes received a second PDT, and 1 eye received 3 PDTs. Two eyes received a second IVK. The GLD of the CNV lesions ranged from 1.0 to 5.2 mm, with a median of 2.8 mm at baseline. The mean visual acuity at baseline was 20/132 with a median of 20/126. The mean visual acuity at 3 months was 20/123, with a median of 20/80. At 6 months, the mean visual acuity was 20/148, with a median of 20/142. The changes in mean visual acuity from baseline to the 3 and 6 month visits were not statistically significant (p = 0.50, and 0.53). The mean FT by OCT at baseline was 327.9 mm, declining to 242.4 mm at 3 months (p = 0.05), and 297.4 mm at 6 months (p = 1.0). The TMV by OCT at baseline was 7.66 mm3, 6.71 mm3 at 3 months (p = 0.08) , and 7.64 mm3 at 6 months (p = 0.84). Two of the 10 eyes developed an intraocular pressure rise over 22 during the study period; both required glaucoma drops. None of the eyes required a trabeculectomy. Of the 6 phakic eyes, 2 had documented cataract progression and 1 required cataract surgery. None of the eyes experienced a retinal detachment, retinal tear, or endophthalmitis. Conclusions: Photodynamic therapy combined with intravitreal triamcinolone injection as the initial treatment of neovascular age–related macular degeneration was found to be reasonably safe. Although this was a small study, the mean visual acuities were relatively preserved, and the decrease in Foveal Thickness at 3 months was borderline significant.
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