Photodynamic therapy combined with posterior subtenon triamcinolone acetonide injection in the treatment of choroidal neovascularization

Abstract

Purpose To evaluate the therapeutic effect of photodynamic therapy (PDT) combined with posterior subtenon injection of triamcinolone acetonide (PSTA) in the treatment of choroidal neovascularization (CNV). Methods In this retrospective case-control study, treatment outcomes at 12 months of patients with CNV were reviewed. One hundred and two consecutive patients (102 eyes) with subfoveal CNV of various causes were included. Patients in the study group (n ¼ 46) received PDT followed within 2 days by 40 mg of PSTA. Patients in the control group (n ¼ 56) received PDT alone. Patients were retreated 3 months later or more if fluorescein angiography showed residual membrane leakage. Treatment outcomes were compared between the two groups and among different CNV subgroups. Results Gain in mean best-corrected visual acuity (BCVA) was significantly higher in the study group ( þ 0.78 lines) than in the control group (À1.86 lines) (Po0.0001). The number of treatments within 1 year was significantly less in the study group (1.26 vs 1.63, P ¼ 0.008). The mean BCVA change for myopic CNV and age-related predominantly classic CNV subgroups was significantly higher in the study group ( þ 2.82 vs À0.91 lines, P ¼ 0.0005 for myopic CNV; þ 0.6 vs À1.79 lines, P ¼ 0.01 for age-related predominantly classic CNV). The main side effect in the study group was increased intraocular pressure (8.7%). ConclusionCompared with PDT alone, PDT combined with PSTA has a better therapeutic effect for both myopic and age-related predominantly classic CNV; the myopic CNV subgroup shows the best response.

Clinical Evidence of Intravitreal Triamcinolone Acetonide in the Management of Age-Related Macular Degeneration

“…The mean VA changes for eyes with predominantly classic CNV was +0.6 (±1.9) lines and for occult CNV was -1.75 (±3.39) lines that resulted better than controls treated with PDT alone. The incidence of IOP elevation and cataract progression was 8.7 and 6.5%, respectively, significantly lower than those reported from the studies using IVTA: 21-43% of IOP elevation, and >57% of cataract progression [55]. The pharmacokinetics of posterior sub-Tenon's triamcinolone injection is currently under investigation.…”

“…The concentration level that this dose could reach in the subretinal space is still unclear, and there is no substantial agreement between the physicians, about the optimal dose to be injected in the human eye. Some authors reported good results even with lower doses of TA (2 mg-Iwama D 2008) [42] [55][56][57][58][59] with fewer side effects like cataract and glaucoma. Nevertheless, in most trials the effect of TA was transient.…”

Ranibizumab therapy for choroidal neovascularization secondary to non‐age‐related macular degeneration causes

“…The poor natural history of CNV has led to several treatment options, including photodynamic therapy, thermal laser, intravitreal triamcinolone and submacular surgery; however, none of these has proven consistent in their therapeutic benefit 6–9 . More recently, treatment of subfoveal CNV in AMD has been revolutionized by anti‐vascular endothelial growth factor (anti‐VEGF) agents 10 .…”

“…[3][4][5] The poor natural history of CNV has led to several treatment options, including photodynamic therapy, thermal laser, intravitreal triamcinolone and submacular surgery; however, none of these has proven consistent in their therapeutic benefit. [6][7][8][9] More recently, treatment of subfoveal CNV in AMD has been revolutionized by anti-vascular endothelial growth factor (anti-VEGF) agents. 10 Although the mechanism of VEGF upregulation in CNV is not clear, inhibition of this growth factor has been effective in closing the membrane, restoring retinal architecture and improving visual acuity (VA).…”