Indocyanine green-mediated photothrombosis with intravitreal triamcinolone acetonide for subfoveal choroidal neovascularization in age-related macular degeneration

Abstract

There is a need for alternative treatments for the management of exudative age-related macular degeneration (AMD). The purpose of this paper is to determine the feasibility, safety, and clinical effect of indocyanine green (ICG)-mediated photothrombosis (IMP) combined with intravitreal triamcinolone acetonide (TA) in patients with subfoveal choroidal neovascularization (CNV) in AMD. Thirty-one eyes of 26 patients who were treated with IMP immediately followed by an intravitreal injection of 4 mg of TA were investigated in the study. The patients had a mean follow-up of 9 months (range 3 months to 26 months). Patients underwent one to four sessions of IMP combined with intravitreal TA. Visual acuity showed stability in 19 eyes (61.3%), improvement of visual acuity (VA) in seven eyes (22.6%), and worsening of VA in five eyes (16.1%). A significant regression of the CNV, and diminishing of subretinal fluid, was demonstrated with fluorescein angiography and optical coherence tomography. We found no complications associated with the intravitreal injection procedure or IMP. Five (16.1%) eyes developed an increase in intraocular pressure related to the presence of TA in the vitreous cavity. However, it was medically controlled with topical anti-glaucoma medications. Nineteen of 31 eyes (61.2%) required at least one re-treatment (mean 1.7; range 1-4) during the study period. Combined IMP and intravitreal TA may provide stability or improvement in visual acuity and fundus findings in choroidal neovascularization. Further evaluation in a multicenter, randomized, placebo-controlled clinical trial with longer follow-up is needed to accurately assess the safety and efficacy of this new treatment modality.