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Combined photodynamic therapy and intravitreal triamcinolone injection for the treatment of choroidal neovascularisation secondary to pathological myopia: a pilot study

Wai-Man Chan¹, Timothy Y Y Lai², Amy L Wong², David T L Liu¹ and Dennis S C Lam²

¹ Department of Ophthalmology & Visual Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, People’s Republic of China
² Department of Ophthalmology & Visual Sciences, Hong Kong Eye Hospital, The Chinese University of Hong Kong, Hong Kong, People’s Republic of China

Correspondence to:
Correspondence to:
Professor W-M Chan
Department of Ophthalmology and Visual Sciences, Hong Kong Eye Hospital, The Chinese University of Hong Kong, 147K Argyle Street, Hong Kong, People’s Republic of China; cwm6373{at}netvigator.com

Background: To assess the efficacy and safety of combined intravitreal triamcinolone (IVTA) and photodynamic therapy (PDT) with verteporfin in the treatment of choroidal neovascularisation (CNV) secondary to pathological myopia.

Methods: 22 eyes of 22 patients with subfoveal or juxtafoveal CNV due to pathological myopia were prospectively recruited for combined PDT with IVTA. The treatment outcomes at 1 year were compared with those in a control group of 22 eyes that received PDT monotherapy.

Results: At 1 year, the logMAR best-corrected visual acuity (BCVA) for the combined PDT with IVTA group changed from 0.62 to 0.61 (p = 0.74), whereas that for the monotherapy group changed from 0.61 to 0.67 (p = 0.33). The mean logMAR BCVA and proportions of patients without losing 3 lines at 1 year were similar between the two groups (p = 0.68 and 0.74, respectively). Subgroup analyses showed that eyes with baseline logMAR BCVA worse than 0.6 (Snellen equivalent 20/80) or CNV with greatest linear dimension 750 µm which received combined therapy had better mean logMAR BCVA at 1 year (p = 0.023 and 0.041, respectively), with a higher proportion of eyes gaining 2 lines of BCVA (p = 0.027 and 0.017, respectively) compared with PDT monotherapy.

Conclusions: Combined PDT with IVTA did not seem to result in significantly better visual outcome compared with PDT monotherapy. However, combined therapy might result in better visual outcome in selected patients with worse initial visual acuity or larger myopic CNV. Further studies are warranted to investigate the role of combined PDT with IVTA in the treatment of myopic CNV, especially in patients with worse prognostic factors.

Abbreviations: AMD, age-related macular degeneration; BCVA, best-corrected visual acuity; CNV, choroidal neovascularisation; GLD, greatest linear dimension; IOP, intraocular pressure; IVTA, intravitreal triamcinolone; PDT, photodynamic therapy; RPE, retinal pigment epithelium

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