413 Intérêt d’une injection intravitréenne de triamcinolone versus intra vitréenne de Bevacizumab combinée à la photothérapie dynamique dans le cas des décollements séreux de l’épithélium pigmentaire compliquant une DMLA exsudative

Abstract

But To compare the short term effectiveness and safety of Intravitreal Triamcinolone Acetonide (IVTA) versus Intravitreal Bevacizumab in the treatment of Pigment Epithelial Detachment (PED) associated with Choroidal Neovascularization secondary to Age Related Macular Degeneration, in patients whom Photodynamic therapy (PDT) with verteporfine had been estimated to increase high risk of pigment epithelial tears. Materials and Methods We prospectively included 29 eyes of 29 patients divided in 2 groups. After appropriate informed consent, patients of group I had an intravitreal injection of 1.25mg/0.05ml of Bevacizumab. Patients of group II received 4mg/0.1ml of triamcinolone acetonide. For the follow up, ETDRS, stereo fundus examination and OCT imaging were performed at week 2 in all cases. Local and systemic adverses effects were evaluated. Patients who had at least 20/200 VA and a partial or completed PED regression were treated with PDT. Results At week 2, group I showed greater mean gain in VA. OCT imaging revealed regression of macula edema and SNRD in all cases as in group II, but less significative regression of the size of the PED. In group I, 5 cases (45.5 %) had no change of the PED. We postponed the PDT procedure in these cases. Three months after PDT, no case of retinal tear was reported. In group I, No endophthalmitis, cataract or elevated IOP were reported, neither systemic adverses effects. In group II, 2 cases of transient IOP elevation (11%) and 3 cataracts in phakic patients were reported. Conclusion The short term anatomical changes observed in our study suggest that intravitreal triamcinolone acetonide is a better effective method to reduce PED in ARMD than intravitreal Bevacizumab in spite of local adverses effects. Which consecutively allows PDT However, further studies are needed to confirm these findings.