Abstract
Abstract: :
Purpose: To examine combined intravitreal triamcinolone acetonide and photodynamic therapy (PDT) for pigment epithelium detachment (PED) secondary to neovascular age–related macular degeneration (AMD). Methods: Interventional case series. Ten patients (10 eyes) with mean age of 74.5 years (range, 70–81 years) with choroidal neovascularization associated with PED, who were not candidates for treatment with PDT, were treated with intravitreal injection of 4 mg of triamcinolone acetonide. Photodynamic therapy with Visudyne was performed 15 days after triamcinolone acetonide, using standard treatment parameters. ETDRS visual acuity (VA), fundus examination, and fundus photography, were performed at baseline and 3,6,9 and 12 months after PDT. Fluorescein angiography (FA), indocyanine green angiography (ICGA), and optical coherence tomography (OCT) were performed at baseline, and 7, 30, 90 days, and at each 3–month follow–up intervals. The CNV was divided into 2 categories by location with respect to the PED: 1) "Beneath", CNV located beneath the PED; 2) and "contiguous", CNV that interrupted the continuity of the margin of the serous PED. The need for re–treatment was considered on fluorescein and ICG angiographic evidence of leakage at 3–month follow–up intervals. Results: Patients had a mean follow–up of 6 months (range: 3 months to 12 months). Six of the 10 eyes had improved VA of at least 2 or more lines at the 3–month and 6–month time points, with the trend continuing in longer term follow–up. Two eyes lost 3 or more ETDRS lines of VA and 2 eyes maintained their initial visual acuity during the follow–up. Subretinal hemorrhage occurred in one eye 15 days after PDT. All patients received one initial combined treatment. One patient underwent an additional combined therapy 6 months after PDT. Complete reapplication of the PED on OCT with absence of leakage of the CNV on both FA and ICGA was observed in 8 out of 10 eyes during the follow–up. No side effects were disclosed. No difference was found between the location of the CNV, the final VA, and the rate of re–treatment. Conclusions: Although the number of patients in this study was limited, our results indicate that PDT combined with intravitreal triamcinolone acetonide seems to be a better therapeutic option than PDT alone for treatment of PED associated with neovascular AMD.
Keywords: age-related macular degeneration • photodynamic therapy • choroid: neovascularization