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V. Chaudhary, A. Mao, P.L. Hooper, T. Sheidow; The Effect of Triamcinolone Acetonide as an Adjunctive Treatment to Verteporfin Therapy in Neovascular Age–Related Macular Degeneration: A Prospective, Randomized, Placebo Controlled Pilot Clinical Trial . Invest. Ophthalmol. Vis. Sci. 2005;46(13):2308.
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Purpose: To evaluate the effect of Triamcinolone Acetonide (TA) as an adjunctive treatment to photodynamic therapy (PDT) on the treatment of ‘occult’ and ‘minimally classic’ sub–foveal choroidal neovascular membranes (CNV) secondary to age–related macular degeneration. Methods: This study is a 1 year prospective, placebo controlled, randomized pilot clinical trial. Twenty patients were enrolled in the study and randomized to either PDT + intravitreal TA injection (treatment group) or PDT alone (control). There were 10 patients in each group. Patients were assessed at baseline, 1 week, 6 week post–treatment and active lesions re–treated at 3. 6. and 9 month intervals. At each visit, Early Treatment of Diabetic Retinopathy Study (ETDRS) VA, contrast sensitivity, fluorescein angiography, optical coherence tomography of the macula was performed. The primary outcome was the proportion of eyes with fewer than 15 letters (approximately 3 lines) of visual acuity loss. Secondary outcomes included number of PDT treatments, change in macular thickness, contrast sensitivity, intraocular pressure and cataract. Results: 6 month results of the study are as follows. In both the control group and the treatment group, 80% of patients lost fewer than 15 letters of visual acuity. No patients in either group experienced severe vision loss (>30 letters). There was no statistically significant change in contrast sensitivity between the groups. Foveal thickness decreased in the treatement group from an average of 395 microns at baseline to 171 microns at 6 months (p<0.0001). In the control group there was no significant change in foveal thicknes. 70% of patients in the control group required retreatment of their lesion based upon angiographic leakage. No patients in the treatment group required retreament. There was no significant difference in cataract progression between the two groups. 30% of patients in the treatment group required topical medication to control intraocular pressure spikes. Conclusions: 6 month data indicates that PDT + intravitreal TA injection is equally effective in limiting vision loss and preserving contrast sensitivity as compared with PDT alone in ‘occult’ and ‘minimally classic’ sub–foveal CNV secondary to AMD. However, combined PDT + intravitreal TA treatment significantly reduces the number of treatments required to result in an inactive lesion and hastens the resolution of macular edema.
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