Treatment of Exudative AMD With Chorioretinal Anastomosis: A Comparative Study Of Photodynamic Therapy With And Without Intravitreal Injection Of Triamcinolone Acetonide

Abstract

Abstract: : Purpose:To assess the potential role of photodynamic therapy with verteporfin alone or preceded by an intravitreal injection of Triamcinolone in the management of exudative age–related macular degeneration (AMD) associated with chorioretinal anastomosis (CRA). Methods:2 series of 14 consecutive patients presenting with exudative AMD and CRA associated with a pigment epithelium detachment (PED) were respectively treated with PDT alone (group A) and PDT after an intravitreal injection of Triamcinolone (group B). All patients had a minimum follow–up of 3 months with 11 patients in each group followed for at least 6.months. In group B, PDT was performed between 1 and 3 weeks following the intravitreal injection of 4 mg of Triamcinolone. Baseline and follow–up examinations included fluorescein angiography (FA), indocyanine green angiography (ICG) with a scanning laser ophthalmoscope and optical coherence tomography (OCT). Results:Mean visual acuity changes at 3 and 6 months were respectively a loss of 0.36 and 0.82 lines in eyes in group A vs. an improvement of 0.86 and 0.09 lines in eyes in group B. Complete reapplication of the PED on OCT with absence of leakage on both FA and ICG was not observed in any eye in group A but was diclosed in group B in 4 out of 14 eyes at the 3–month control and 2 out of 11 eyes at the 6–month control. FA and ICG showed an increase of the size of the lesion in 7 out of 14 eyes at 3 months and 7 out of 11 eyes (64%) at 6 months in group A vs. 3 out of 14 eyes and 4 out of 11 eyes (36%) respectively in group B. The study is still ongoing. Conclusions:This pilot prospective comparative study suggests that intravitreal injection of Triamcinolone followed by PDT is a better therapeutic option than PDT alone in the management of exudative AMD associated with CRA. Further investigation with larger number of patients and longer follow–up is warranted.

Keywords: age–related macular degeneration • photodynamic therapy • corticosteroids