Verteporfin therapy combined with intravitreal triamcinolone in all types of choroidal neovascularization due to age-related macular degeneration.

Abstract

OBJECTIVE:

To evaluate the efficacy and safety of photodynamic therapy with verteporfin combined with intravitreal triamcinolone in choroidal neovascularization secondary to age-related macular degeneration (AMD).

DESIGN:

Prospective, noncomparative, interventional case series.

PARTICIPANTS:

One hundred eighty-four patients undergoing treatment for neovascular AMD at one retinal referral center.

METHODS:

One hundred eighty-four eyes of 184 consecutive patients (63.6% female, 36.4% male) with a mean age of 76.5 years and a follow-up of a median of 38.8 weeks (range, 12-103) were included in a case series. One hundred forty-eight (80.4%) patients had subfoveal choroidal neovascularization, 19 patients (10.3%) had juxtafoveal choroidal neovascularization, and 17 patients (9.2%) had extrafoveal choroidal neovascularization. Verteporfin photodynamic therapy was performed using the recommended standard procedure. A solution containing 25 mg of triamcinolone was injected intravitreally 16 hours after photodynamic therapy in 184 patients. The combined therapy procedure was repeated at the 3-month follow-up visits whenever persistent choroidal neovascularization leakage was documented angiographically.

MAIN OUTCOME MEASURES:

Mean change in best-refracted visual acuity (VA) between baseline and the last visit, and number of treatments necessary to achieve absence of leakage.

RESULTS:

Visual acuity improved in the majority of patients (baseline VA, mean 20/125) by a mean increase of 1.22 Snellen lines and 1.43 lines using laser interferometry (P<0.01). The mean number of required treatments was 1.21. Twenty-three eyes (12.5%) required 2 treatments, 6 eyes (3.26%) required 3 treatments, and 1 eye (0.5%) required 4 treatments. The combination treatment including laser and intravitreal steroid administration was well tolerated. Forty-six patients (25%) required glaucoma therapy due to a transient steroid-induced intraocular pressure (IOP) increase. Twelve patients (6.5%) were on topical medication for preexisting glaucoma. Two patients (1%) whose IOP increase could not be controlled with topical therapy required surgery.

CONCLUSIONS:

Verteporfin photodynamic therapy combined with intravitreal triamcinolone may improve the outcome of standard verteporfin photodynamic therapy in the treatment of choroidal neovascularization secondary to AMD. A significant improvement in VA was observed in a majority of treated patients and was maintained during the maximum follow-up. In addition, retreatment rates were lower than anticipated.

• Authors: Albert J Augustin, Ursula Schmidt-Erfurth
• Journal: Ophthalmology (Ophthalmology) Vol. 113 Issue 1 Pg. 14-22 (Jan 2006) ISSN: 1549-4713 [Electronic] United States
• PMID: 16360209 (Publication Type: Journal Article)

Chemical References

• Glucocorticoids
• Photosensitizing Agents
• Porphyrins
• Verteporfin
• Triamcinolone Acetonide

Topics

• Aged
• Choroidal Neovascularization (drug therapy, etiology)
• Combined Modality Therapy
• Drug Therapy, Combination
• Female
• Fluorescein Angiography
• Glucocorticoids (adverse effects, therapeutic use)
• Humans
• Injections
• Macular Degeneration (complications, drug therapy)
• Male
• Photochemotherapy
• Photosensitizing Agents (adverse effects, therapeutic use)
• Porphyrins (adverse effects, therapeutic use)
• Retreatment
• Treatment Outcome
• Triamcinolone Acetonide (adverse effects, therapeutic use)
• Verteporfin
• Visual Acuity
• Vitreous Body (drug effects)