Intravitreal Triamcinolone Combined with Photodynamic Therapy for Choroidal Neovascularization Associated with Age–related Macular Degeneration

Abstract

Abstract: : Purpose: To study the effect of intravitreal injection of triamcinolone combined with photodynamic therapy with visudyne as treatment for subfoveal choroidal neovascularization associated with age–related macular degeneration (ARMD). Methods: Forty three eyes of forty patients with subfoveal choroidal neovascularization associated with ARMD were treated. The median visual acuity before treatment was 20/400 (mean log MAR vision = 20/318). All patients were evaluated with pre–treatment fluorecein angiography (FA). The mean greatest linear diameter of choroidal neovascularization was 4.3 mm. Thirty eyes had received prior visudyne treatment with an incomplete response or significant residual subretinal fluid despite photodynamic therapy. Thirteen eyes had not received prior therapy. Treatment consisted of a single intravitreal injection of 4 mg of triamcinolone through the pars plana under sterile conditions, performed 1 week prior to visudyne treatment. FA evaluation was repeated at 1 month, 3 month, and 6 month follow–up visits and photodynamic therapy was repeated if leakage persisted. Results: No patient experienced severe visual loss over the follow–up period. Even though the median visual acuity remained 20/400 at the 6 month follow–up, the mean vision improved to 20/217. Resolution of subretinal fluid was seen in 51% of eyes and a decrease in subretinal fluid was noted in an additional 42% of eyes. Resolution of leakage on FA was seen in 52% of eyes and a decrease in leakage on FA was evident in an additional 33% of eyes. Of the thirteen eyes without prior treatment, ten had resolution of the choroidal neovascularization at 1 month. Conclusions: Intravitreal injection of triamcinolone combined with photodynamic therapy appears to be an effective treatment modality for choroidal neovascularization in patients with ARMD, especially when photodynamic therapy alone fails to induce resolution of subretinal fluid. The precise indication for this combination therapy requires further study.

Keywords: age–related macular degeneration • photodynamic therapy • choroid: neovascularization