Elsevier

Ophthalmology

Volume 112, Issue 2, February 2005, Pages 301-304
Ophthalmology

Original article
Photodynamic therapy with verteporfin combined with intravitreal injection of triamcinolone acetonide for choroidal neovascularization

Presented at: American Academy of Ophthalmology Annual Meeting, October, 2003; New Orleans, Louisiana.
https://doi.org/10.1016/j.ophtha.2004.08.012Get rights and content

Purpose

To examine the 12-month results of a group of patients treated with combined photodynamic therapy (PDT) with verteporfin and intravitreal triamcinolone acetonide for choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD).

Design

Noncomparative case series.

Participants

Twenty-six eyes of 26 patients with CNV secondary to AMD. Thirteen with CNV, without restriction to type, were not treated with prior PDT (newly treated group). Thirteen patients with prior PDT therapy who experienced visual loss while being treated with PDT alone comprised the remainder (prior PDT group).

Methods

Patients with CNV were treated with PDT, immediately followed by an intravitreal injection of 4 mg of triamcinolone acetonide. Visual acuity was measured by Early Treatment Diabetic Retinopathy Study protocol refraction. Need for retreatment was based on fluorescein angiographic evidence of leakage at 3-month follow-up intervals.

Main outcome measures

Visual acuity and retreatment rate.

Results

In the newly treated group, the mean acuity change was an improvement of 2.5 lines (last observation carried forward [LOCF], +2.4 lines; P = 0.011, Wilcoxon signed ranks test, as compared with baseline acuity) for patients completing the 12-month follow-up. In the prior PDT group, the mean change was an improvement of +0.44 lines (LOCF, +0.31 lines; P = 0.53). Retreatment rates were 1.24 for the newly treated group and 1.2 for the prior PDT group over the first year. Ten patients (38.5%) developed an intraocular pressure (IOP) of >24 mmHg during follow-up, a threshold used to institute pressure reduction therapy. No patient developed endophthalmitis.

Conclusion

Although the number of patients in this pilot study was limited, the improvement of acuity and the reduced treatment frequency in these patients suggest that combination therapy with PDT and intravitreal triamcinolone acetonide, particularly when used as first-line therapy, merits further investigation. Elevated IOP seems to be the most frequent early side effect of the treatment.

Section snippets

Patients and methods

We conducted a prospective study of combined PDT with verteporfin and intravitreal injection of triamcinolone acetonide in patients with CNV secondary to AMD. This study was approved by the Institutional Review Board of Manhattan Eye, Ear and Throat Hospital and was compliant with the Health Insurance Portability and Accountability Act of 1996, and participating patients signed an informed consent. The patients were seen in the referral practice of the Vitreous–Retina–Macula Consultants of New

Results

There were 26 eyes of 26 patients enrolled in the study. The mean age was 76.2 years (standard deviation [SD], 7.6), the baseline Snellen equivalent acuity had a mean of 20/160 and a median of 20/160, and there was no difference in these baseline characteristics between the newly treated and prior PDT groups. There were 5 patients with predominantly classic CNV, 4 with minimally classic CNV, and 4 with occult CNV. Among the prior PDT group, the number of previous treatments had a mean of 2.9, a

Discussion

This single-center prospective pilot study examining the use of PDT combined with verteporfin and intravitreal triamcinolone found a potential benefit at 1 year in the treatment of CNV secondary to AMD. In both the newly treated group and the prior PDT group, patients required fewer repeat treatments during follow-up than would have been expected using PDT alone. At the 12-month follow-up, the mean acuity improved in a statistically significant manner as compared with baseline in the newly

References (29)

  • Treatment of Age-Related Macular Degeneration with Photodynamic Therapy Study Group, Verteporfin in Photodynamic...
  • M.C. Killingsworth et al.

    Macrophages related to Bruch's membrane in age-related macular degeneration

    Eye

    (1990)
  • K. Dastgheib et al.

    Granulomatous reaction to Bruch's membrane in age-related macular degeneration

    Arch Ophthalmol

    (1994)
  • H. Oh et al.

    The potential angiogenic role of macrophages in the formation of choroidal neovascular membranes

    Invest Ophthalmol Vis Sci

    (1999)

    • Cited by (0)

    Manuscript no. 240038.

    Supported by The Macula Foundation, Inc., New York, New York.

    The authors have no financial interests in the materials and methods mentioned in this article.

    View full text
    Copyright © 2005 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.