Effectiveness of Transpupillary Thermotherapy and Intravitreous Triamcinolone in the Treatment of Large Choroidal Neovascularization Secondary to Age–Related Macular Degeneration

Abstract

Abstract: : Purpose: To determine the effectiveness of Transpupillary Thermotherapy (TTT) associated with intravitreous triamcinolone acetonide for treatment of large choroidal neovascularization (CNV) secondary to Age–Related Macular Degeneration (ARMD). Methods: Prospective, longitudinal, experimental and comparative study. We included patients with large CNV secondary to ARMD, regardless angiographic pattern, who rejected Photodynamic Therapy for economical reasons; they were randomized to receive treatment with TTT in group A (gA) or Triamcinolone Acetonide 4 mg intravitreous once and TTT one week later in group B (gB). Best Corrected Visual Acuity (BCVA), IOP, clinical aspect, foveal thickness (FT) and presence of subfoveal fluid by Optical Computerized Tomography and fluorescein angiography were evaluated. Results: Complete records are available on 15 patients, 9 assigned to gA and 6 to gB, average age was 76 years, 55% (8/15) females, no significant demographic differences between groups. CNV was predominantly occult in 55% (5/9) of patients in gA and 80% (5/6) of gB. CNV was larger in gB (7.40 disc diameter vs 2.75 in gA). Large fibrous component was more frequent in gB. Average FT was 412 um gA vs 469 um gB, average baseline BCVA by ETDRS chart was count fingers (CF) 4 m in gA and CF 3 m in gB. Mean follow–up was 4 months (range: 3–6 mos). At the end of the study, average BCVA was 20/200 for gA and CF 3m for gB. Patients in gA showed improvement of 1 line of vision, whereas patients in gB showed no change. Post–treatment FT was 319 um in gA and 501 um in gB. Membrane closure was obtained in 40% (4/9) of gA patients and 33% of gB (2/6). CNV mean size reduction was 7% in gA and 36% in gB. This clinical difference was not statistically significant, probably secondary to lesion severity. Complications: 2 patients in gB (33.3%) presented a significant IOP increase treated with beta–blockers. Conclusions: TTT is an alternative to stabilize large CNV secondary to ARMD. Intravitreous triamcinolone may improve membrane size reduction with minimal complications. Triamcinolone as an adjuvant of TTT can stabilize large CNV.

Keywords: age–related macular degeneration • clinical (human) or epidemiologic studies: outcomes/complications • retinal neovascularization