Document Detail


Verteporfin therapy combined with intravitreal triamcinolone in all types of choroidal neovascularization due to age-related macular degeneration.
MedLine Citation:
PMID:  16360209     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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
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Publication Detail:
Type:  Journal Article     Date:  2005-12-19
Journal Detail:
Title:  Ophthalmology     Volume:  113     ISSN:  1549-4713     ISO Abbreviation:  Ophthalmology     Publication Date:  2006 Jan 
Date Detail:
Created Date:  2006-01-03     Completed Date:  2006-01-10     Revised Date:  2006-11-21    
Medline Journal Info:
Nlm Unique ID:  7802443     Medline TA:  Ophthalmology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  14-22     Citation Subset:  IM    
Affiliation:
Department of Ophthalmology, Klinikum Karlsruhe, Karlsruhe, Germany. 106020.560@compuserve.com
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MeSH Terms
Descriptor/Qualifier:
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*
Visual Acuity
Vitreous Body / drug effects
Chemical
Reg. No./Substance:
0/Glucocorticoids; 0/Photosensitizing Agents; 0/Porphyrins; 129497-78-5/verteporfin; 76-25-5/Triamcinolone Acetonide
Comments/Corrections
Comment In:
Ophthalmology. 2006 Nov;113(11):2109-10   [PMID:  17074571 ]
Ophthalmology. 2006 Aug;113(8):1470-1   [PMID:  16877087 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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