COMBINATION TREATMENT WITH REDUCED-FLUENCE PHOTODYNAMIC THERAPY AND INTRAVITREAL INJECTION OF TRIAMCINOLONE FOR SUBFOVEAL CHOROIDAL NEOVASCULARIZATION IN MACULAR DEGENERATION

In Brief Purpose: To evaluate combination treatment with reduced-fluence photodynamic therapy (PDT) and intravitreal triamcinolone acetonide (IVT) injection for choroidal neovascularization (CNV) in age-related macular degeneration (AMD). Methods: This is a retrospective consecutive case series of 23 previously untreated eyes of 22 patients with subfoveal CNV secondary to AMD. Six eyes were treated with 50 J/cm2; 8, with 40 J/cm2; and 9, with 25 J/cm2. PDT was immediately followed by a 4-mg IVT injection. Patients were observed for 6 months at 6-week intervals. Results: The 50 J/cm2 subset lost a mean of 2.2 lines of Snellen visual acuity at the 6-month follow-up compared with a 1-line lost in the 40 J/cm2 subset and a 0.9-line gain in the 25 J/cm2 subset. In the 50 J/cm2 subset, 60% lost ≤3 lines of Snellen visual acuity, 33% gained ≥0 line, and 33% gained ≥3 lines. In the 40 J/cm2 subset, 75% lost ≤3 lines of Snellen visual acuity, 50% gained ≥0 line, and 25% gained ≥3 lines. In the 25 J/cm2 subset, 89% lost ≤3 lines of Snellen visual acuity, 56% gained ≥0 line, and 33% gained ≥3 lines. Fifty percent of the 50 J/cm2 subset, 50% of the 40 J/cm2 subset, and 33% of the 25 J/cm2 subset required retreatment by 6 months. Conclusion: Although the sample in this study was small, there was a dose–response trend toward better visual outcomes and fewer treatments in the group treated with IVT injection and reduced-fluence PDT. This study along with other previously reported work suggests that studies using PDT in combination treatment for CNV should consider adding a reduced-fluence PDT arm. In a study of combination treatment with reduced-fluence photodynamic therapy (PDT) and intravitreal triamcinolone acetonide (IVT) injection for choroidal neovascularization (CNV) in age-related macular degeneration, there was a dose–response trend toward better visual outcomes and fewer treatments in the group treated with IVT injection and reduced-fluence PDT. This study along with other previously reported work suggests that studies using PDT in combination treatment for CNV should consider adding a reduced-fluence PDT arm.