Combination of Photodynamic Therapy and Intraocular Triamcinolone for Exudative Age-Related Macular Degeneration and Long-Term Chorioretinal Macular Atrophy

Abstract

Objective: To evaluate the long-term effect of intravitreal triamcinolone acetonide (IVT) treatment combined with photodynamic therapy (PDT) vs PDT alone for neovascular age-related macular degeneration.Methods: Prospective randomized study. Eighty-four patients were enrolled to receive PDT (n=41) or IVT treatment followed by PDT (n=43) within approximately a 7-to 15day interval. All patients were naive to treatment. At baseline and each follow-up visit at 3, 6, 12, and 24 months, measurement of best-corrected visual acuity (VA), fluorescein angiography, indocyanine green angiography, and optical coherence tomography were performed. Mean changes in VA and retreatment rate were considered as primary outcomeindicators.Analysisofvascularchoroidalchangesdocumented by indocyanine green angiography and fundus autofluorescence measurements were also performed. Results:Mean VA increased at 1 month of follow-up but decreased progressively by the 24-month point in both groups (P=.74). The retreatment rate was significantly lower (P Ͻ .001) in the combined therapy group. Choroidal hypoperfusion/nonperfusion (PϽ.001) and areas with decreased/absent fundus autofluorescence within the PDT spot area were significantly greater with combined therapy (PϽ .001). Conclusions:Combination IVT treatment with PDT seemed to be more effective for managing neovascular age-related macular degeneration, but long-term analysis failed to demonstrate functional benefits.

A randomised prospective double-masked exploratory study comparing combination photodynamic treatment and intravitreal ranibizumab vs intravitreal ranibizumab monotherapy in the treatment of neovascular age-related macular degeneration

“…Reduced choroidal perfusion is a known consequence of PDT therapy as treatment temporarily closes small-and medium-sized choroidal vessels as well as CNV. 9 Concurrent treatment with both steroids 10 and ranibizumab 11 prolong reduced choroidal perfusion. The PROTECT study 11 demonstrated reduced choroidal perfusion using indocyanine green angiography that persisted over 9 months of follow-up in 10 of 11 patients.…”

Choroidal Infarction After Photodynamic Therapy Combined With Bevacizumab and Triamcinolone Reversed by Tissue Plasminogen Activator

“…[1][2][3][4][5] Indocyanine green angiography studies 3,4 in those cases showed that there was a longer duration of choroidal hypoperfusion in patients with combined treatment. There have been some reports indicating that combined therapy decreases the number of PDT treatment and achieves a better visual outcome.…”

“…[1][2][3][4][5][6] Prolonged choroidal hypoperfusion after combined treatment of PDT with either TA or anti-VEGF has been reported in previous reports [3][4][5] and is presumed to be a key factor in the delay of recurrence of CNV. It selectively photothromboses neovascular lesions.…”

Alternative approach to laser methods of treating vascular pathologies of the eye

“…11 Second, the need for repeated injections is intensified by the indeterminacy of the results of the treatment. 12,13 Finally, the widespread use of Lucentis for treating AMD is hindered by its high cost-one injection costs about $2000, and a two-year course of treatment about $40,000. 14 The restriction of injections with the promise of increased visual acuity is associated with the synthesis of a new generation of inhibitors of growth factors of choroidal cells, such as VEGF Trap-Eye (aflibercept), EGFR, etc.…”