Traitement simultané par photothérapie dynamique et triamcinolone intravitréenne des néovaisseaux associés à un décollement de l’épithélium pigmentaire

Abstract

To assess the advantages of a treatment combining dynamic phototherapy with intravitreally injected Kenacort (triamcinolone acetonide) administered on the same day for choroidal neovascularization with pigment epithelium detachment in age-related macular degeneration. This prospective study involved 24 patients (26 eyes) with pigment epithelium detachment. Each patient underwent dynamic phototherapy according to standard parameters, followed 2 h later by intravitreal injection of 4 mg Kenacort (triamcinolone acetonide) performed in the operating room. The effectiveness of the treatment was assessed with an ETDRS vision test and optical coherence tomography before the operation and again 1, 3, and 6 months later. The group of 24 patients (26 eyes) included 17 women and seven men whose mean age was 77 years (+/-6). In half of the cases, it was the second eye affected by age-related macular degeneration. Major inflammatory reaction following intravitreal injection was resolved within 24 h by local anti-inflammatory treatment. Baseline visual acuity was 40 characters on the ETDRS (+/-15) and final vision was significantly improved to 43 characters (+/-19) after 3 months. Three patients (12%) had their vision improved by more than three lines. For 19 patients (79%), the treatment eliminated pigment epithelium detachment after 1 month, with no recurrence. No single recognized treatment exists for pigment epithelium detachment. Photodynamic therapy has not proven effective, according to the TAP study. For the last few years, several teams have recommended intravitreal injections of Kenacort (triamcinolone acetonide) as a complement to photodynamic therapy to treat different types of choroidal neovascularization. This combination has also been tried in the treatment of pigment epithelium detachment associated with age-related macular degeneration, although the protocol has not yet been clearly established. In order to decrease the cost of treatment by reducing the transport back and forth between the patient's home and the hospital, we have administered this dual treatment on the same day and evaluated the benefits for the patient. We have obtained very satisfactory anatomical results, making it possible to proceed with low-vision rehabilitation, and eventually improve visual acuity. The results of this study indicate that a level of efficiency at least as high as that of treatment at two different times for occult choroidal neovascularization complicated by pigment epithelium detachment can be achieved by a dual treatment the same day, with an accompanying reduction in cost.