Triple therapy for the treatment of choroidal neovascularization with pigment epithelium detachment in age‐related macular degeneration

Abstract

Abstract Purpose To investigate the effect of a triple therapy associating sub‐cunjonctival Triamcinolone acetonide, intravitreous Ranibizumab and photodynamic therapy for treatment of retinal pigment epithelium detachment complicating occult choroidal neovascularization in age‐related macular degeneration. Methods A prospective clinical trial including 30 patients showing retinal pigment epithelium detachment. We treated these patients with intravitreous Ranibizumab injections and sub‐conjuctival Triamcinolone injections as well as a single session of photodynamic therapy at 48 h. At least two more intravitreous Ranibizumab injections were added at 1‐month intervals. Results Initial visual acuity was 20/100 and 20/60 at 9 months, which was minimal follow‐up. Twenty‐five patients had total resumption of retinal pigment epithelium detachment on optical coherence tomography imaging after 1 month. One patient had ocular hypertension and we cut conjonctiva to remove Triamcinolone. After three days the patients had a normal intraocular pression. One had a pigment epithelium break but with good functional results. Ten patients needed six intravitreous injections of Ranibizumab with partial or total resumption in six cases. Conclusion Treatment of retinal pigment epithelium detachment is difficult. Associating intravitreous injection of Ranibizumab, dynamic phototherapy, and sub‐conjunctival Triamcinolone provides good results. The sub‐cunjunctival administration allows to treat hypertonia.