Verteporfin Therapy Combined with Intravitreal Triamcinolone in All Types of Choroidal Neovascularization due to Age-Related Macular Degeneration
Received 22 March 2005; accepted 1 September 2005. published online 19 December 2005.
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.
1Department of Ophthalmology, Klinikum Karlsruhe, Karlsruhe, Germany.
2Department of Ophthalmology, Medical University of Vienna, Vienna, Austria.
Correspondence and reprint requests to Albert J. Augustin, MD, Department of Ophthalmology, Klinikum Karlsruhe, Moltkestrasse 90, 76133 Karlsruhe, Germany.
Manuscript no. 2005-256.
Dr Schmidt-Erfurth is an inventor on the patent on the use of verteporfin therapy in ocular neovascular disease under the guidelines of the Wellman Laboratories of Photomedicine, Harvard Medical School, Boston, Massachusetts (institutional Patent Policy and Procedures).
ABSTRACT