Standard Photodynamic Therapy Research Articles

A Pilot Study on the Combination Treatment of Reduced-Fluence Photodynamic Therapy, Intravitreal Ranibizumab, Intravitreal Dexamethasone and Oral Minocycline for Neovascular Age-Related Macular Degeneration

Aim: To assess the safety and efficacy of the combined treatment of reduced-fluence verteporfin photodynamic therapy (PDT), intravitreal ranibizumab, intravitreal dexamethasone and oral minocycline for choroidal neovascularisa- tion (CNV) secondary to age-related macular degeneration (AMD). Methods: Nineteen patients with subfoveal CNV secondary to AMD were recruited into the trial. All study eyes (n = 19) received a single cycle of reduced-fluence (25 mJ/cm²) PDT with verteporfin followed by an intravitreal injection of ranibizumab 0.3 mg/0.05 ml and dexamethasone 200 µg at baseline. Oral minocycline 100 mg daily was started the following day and continued for 3 months. Patients were followed up monthly for 12 months. Repeat intravitreal ranibizumab was given if best-corrected visual acuity (BCVA) deteriorated by >5 letters on the Early Treatment Diabetic Retinopathy Study (ETDRS) chart or central retinal thickness (CRT) on ocular coherence tomography increased >100 µm. Results: Eighteen patients completed the 12-month study. Stable vision (loss of ≤15 ETDRS letters) was maintained in 89% eyes (16/18). The mean change in BCVA was –5.0 ± 10.5 ETDRS letters. The mean number of ranibizumab injections was 3.4 (range 2–6). The mean reduction in the CRT was 66.3 µm (±75). Conclusion: This open-label clinical trial has demonstrated the safety in terms of adverse effects and maintenance of stable vision of combination treatment with verteporfin, ranibizumab, dexamethasone and minocycline in exudative AMD. However, the outcomes with reduced-fluence PDT combination therapy does not differ significantly with outcomes of clinical trials on combination treatment with standard dose PDT and intravitreal ranibizumab in neovascular AMD.

Standard versus Bolus Photodynamic Therapy in Circumscribed Choroidal Hemangioma: Functional Outcomes

To compare standard versus bolus photodynamic therapy (PDT) in the treatment of symptomatic circumscribed choroidal hemangioma (CCH). Twenty consecutive cases of CCH were included in this prospective randomized study. Each patient was randomly assigned to receive either standard PDT (10-minute 6 mg/mq2 verteporfin infusion; treatment at 15 min; 50 J/cm2; 83 s) or bolus PDT (6 mg/mq2 verteporfin infusion bolus in 1 min; treatment at 5 min; 100 J/cm2; 166 s). Best-corrected visual acuity (BCVA), fundus photography, optical coherence tomography, fluorescein, and indocyanine green angiography were performed at baseline and during follow-up. Retinal sensitivity was tested with microperimetry before and after treatment. Follow-up was longer than 32 months. Mean follow-up was 58±11 months. All cases (100%) showed clinical regression of the treated lesion. Neuroretinal and retinal pigment epithelium (RPE) changes were found in 9 (90%) bolus PDT over treated area. No similar RPE changes were found in patients treated with standard PDT. There was a no statistically significant difference in BCVA outcome between the 2 groups (p=0.078). Microperimetry revealed reduced sensitivity over the treated area in 7 bolus PDT vs 1 in standard treated eyes (p=0.008). Both standard and bolus PDT induce regression of symptomatic CCH. Bolus PDT may cause RPE and retinal changes associated with reduced retinal sensitivity.

Temporary exudative retinal detachment following photodynamic therapy in a patient with retinal capillary hemangioblastoma

A 21-year-old male with von Hippel-Lindau syndrome was treated for a retinal hemangioblastoma with photodynamic therapy (PDT). We employed the standard PDT protocol with doubled treatment duration. Seven days after the procedure, there were some perilesional intra- and subretinal hemorrhages and significant exudative retinal detachment extending inferiorly. Four weeks later, the hemorrhages had mostly cleared, and diminished subretinal fluid and partial regression of the hemangioblastoma were noted. PDT might induce temporary subretinal fluid accumulation in eyes with retinal hemangiomas.

Verteporfin photodynamic therapy of six eyes with retinal capillary haemangioma

Single-centre consecutive interventional case series by retrospective chart review to evaluate the efficacy of verteporfin (Visudyne™) photodynamic therapy (PDT) of retinal capillary haemangioma (RCH). Following an initial period of observation, six eyes of five patients with RCH (juxtapapillary 3 and extrapapillary (EP) 3) received 1-3 sessions of standard verteporfin PDT upon the development of progressive vision-threatening complications. Four of the five patients had von Hippel-Lindau (VHL) disease. Follow-up included documentation of best-corrected Snellen visual acuity (BCVA), tumour regression, and presence or absence of subretinal fluid (SRF) and/or lipid exudation as assessed by dilated fundus examination (DFE), fundus photos, and optical coherence tomography (OCT). These parameters were documented at 1 week, 1 month, and 3 months following each PDT session and up to 32 months following the first PDT. All eyes showed favourable response to PDT as defined by tumour regression or stabilization as well as improvement of SRF and lipid exudation. BCVA improved or stabilized in three eyes. Three eyes required PDT retreatment for recurrent SRF. Epiretinal membrane (ERM) worsened in three eyes, requiring vitreoretinal surgery at a median of 6 months following PDT. PDT is a moderately effective treatment for juxtapapillary and EP RCH. In this series, PDT resulted in tumour regression or stabilization as well as in the improvement of SRF and lipid exudation in all cases. However, stabilization or improvement of visual acuity was observed in only 50 per cent of the cases. The treatment benefits may be limited by pre-existing macular changes and worsening of ERM. A larger prospective study is necessary to validate these findings.

Intravitreal ranibizumab, photodynamic therapy, and vitreous surgery for the treatment of juxtapapillary retinal capillary hemangioma

Dear Editor, Retinal capillary hemangiomas (RCH) are capillary angiomatous hamartomas of the retina and optic nerve head. The median age of diagnosing the disease is 31 years old [1]. Although most RCH is isolated, 10–30% in the 31–40 age group are associated with Von Hippel Lindau disease (VHL). Up to 15% of RCHs are juxtapapillary, where most are located temporally [2]. They are often associated with epiretinal membrane (ERM) formation and serous and tractional retinal detachment of the macula, which leads to a poor prognosis [1]. We report a typical case of isolated juxtapapillary RCH that underwent successful combined therapy with intravitreal ranibizumab injection and photodynamic therapy (PDT) 1 week before PPV and ERM peeling surgery. A 32-year-old woman presented with reduced right eye vision and metamorphopsia for 3 months. At presentation, her best-corrected visual acuity was 20/50 and 20/25 for the right and left eyes, respectively. Right eye fundus examination revealed a reddish mass measuring 2.0 × 1.5 mm in the inferotemporal juxtapapillary region associated with macular subretinal fluid and ERM (Fig. 1a). Fig. 1 Imaging results (color fundus photography, FFA and OCT) of the patient at initial presentation. a Fundus photograph of the right eye showing juxtapapillary retinal capillary hemangioma, measured 2.0 × 1.5 mm, located inferotemporal ... Fundus fluorescein angiogram (FFA) showed early filling of the lesion with late leakage into the subretinal space. Anomalous vascular channels were seen sprouting from the lesion (Fig. 1b). Optical coherence tomography (OCT) confirmed serous detachment of the macula with vitreomacular traction (Fig. 1c). Central foveal thickness was increased to 570 µm (normal values = < 315 µm) [3]. A diagnosis of juxtapapillary retinal capillary hemangioma was made. Systemic workup for Von Hippel Lindau (VHL) disease did not reveal any other tumors. Her visual acuity continued to deteriorate to 20/100 in the subsequent 2 months. She was treated once with PDT using standard fluence at that time, with reduced diameter laser spot centering on the lesion avoiding the optic disc. There was no clinical response and her vision continued to deteriorate to 20/200 3 months after the initial PDT. Combined therapy, using standard fluence PDT and intravitreal injection of ranibizumab were performed 2 months later (7 months since presentation). Reduction of lesion size (1.5 × 1.5 mm) and vascularity was noted 1 day after the combined therapy (Fig. 2a). One week later, PPV and ERM peel were carried out and intravitreal triamcinolone injection (2 mg in 0.05 ml) was given at the conclusion of surgery. Fig. 2 Imaging results (color fundus photography and FFA) of the patient after combined treatment with injection of ranibizumab, PDT, and intravitreal surgery. a Day 1 after combined intravitreal ranibizumab injection and PDT, showing regression of the tumor ... The patient's visual acuity improved to 20/25 after successful surgery and the lesion remained stable for 12 months, up to the latest follow-up (Fig. 2b). The central foveal thickness remained reduced within normal limits at 324 μm. FFA showed hyperfluorescence in the late phase (Fig. 2c). A small superotemporal branch retinal vein occlusion developed secondary to an iatrogenic break resolved spontaneously.

PHOTODYNAMIC THERAPY WITH VERTEPORFIN FOR AVASCULAR SEROUS PIGMENT EPITHELIAL DETACHMENT IN ELDERLY KOREANS

To evaluate the efficacy of photodynamic therapy (PDT) with verteporfin for avascular serous pigment epithelial detachment (PED) in elderly Korean patients. We retrospectively analyzed the medical records of 5 consecutive patients (7 eyes) who presented with a single large (>1 disk diameter) serous PED without clinical signs of soft drusen. Evident or faint choroidal hyperfluorescence was observed around the PED on indocyanine green angiogram (ICGA). Standard PDT was performed with laser spot covering the PED area. The mean follow-up period was 17 months (range, 12-31 months). Five eyes (71%) of 4 patients showed complete resolution of the PED with visual improvement 1 month post-PDT, and these results were sustained during the follow-up period. In the remaining 2 eyes (29%) of 1 patient, there was no change in PED with stable or decreased vision. Vision-threatening adverse events did not occur. In elderly Asians, it is uncertain whether large serous PED without soft drusen is associated with age-related macular degeneration. Most of these PEDs may represent a variant of central serous chorioretinopathy in the elderly and PDT for these lesions showed encouraging results.

The effects of the electro-photodynamic in vitro treatment on human lung adenocarcinoma cells

The effectiveness of the photodynamic therapy (PDT), a low-invasive and targeted therapy of cancer, could be intensified by increasing the intracellular transport of a photosensitizer. The electroporation is used to generate non-specific transient nanopores that facilitate local drug delivery into cells. Photodynamic therapy assisted by electroporation was tested in vitro on the human lung carcinoma cell line A549 by determining the mitochondrial cell function using the MTT assay. The photodynamic activity of the electro-photodynamic treatment (EPDT) with the hematoporphyrin derivative was evaluated in relation to the photodynamic method alone. The experiments show significantly increased efficiency of EPDT, which allows reducing drug doses and exposure time of the cells to the drug in standard PDT. The results have been confronted with the model based on van't Hoff equation. This showed that the growth fractions of cells after EPDT depend on the electric field according to the same relation as in case of electroporation alone.

Intravitreal Triamcinolone Acetonide Preceding Photodynamic Therapy for Exudative Age-Related Macular Degeneration

To evaluate the efficacy of intravitreal triamcinolone acetonide 1 week before photodynamic therapy (PDT) with verteporfin in the treatment of exudative age-related macular degeneration (AMD). Retrospective chart review of 70 eyes of 66 consecutive patients who were treated with intravitreal triamcinolone acetonide followed by standard PDT 1 week later. Group 1 consisted of 42 eyes that received one or more previous treatments with PDT alone and responded poorly. Group 2 consisted of 28 eyes that had never received PDT. No statistically significant change in mean visual acuity was seen during the follow-up period for either group. At 12 months, 90% of group 1 eyes and 80% of group 2 eyes lost less than 2 lines of Snellen visual acuity. A mean of 1.24 additional PDT sessions were required in group 1 eyes and 1.04 additional sessions in group 2 eyes during the follow-up period. In eyes with exudative AMD, intravitreal triamcinolone acetonide preceding PDT with verteporfin results in stabilization of visual acuity and a decreased need for re-treatments with PDT. This regimen may be superior to PDT monotherapy.

A Method for Improving the Efficiency of Therapy for Melanoma

A method for photodynamic therapy was developed in experiments on the model of melanoma B16. The photosensitizer is injected by two doses, while laser exposure is carried out during coincidence of its maximum accumulation phases in tumor vessels and cells. This method increased the percentage of animals with complete regression of the tumor, decreased the coefficient of absolute tumor increase in animals with progressive tumor growth, increased survival of mice, and significantly decreased melanoma metastasizing to the lungs in comparison with untreated animals and even with the standard photodynamic therapy.

Photodynamic therapy with intravitreal application of triamcinolone acetonide in age‐related macular degeneration: functional results in 54 patients

This study aimed to investigate the functional results, efficacy and complications after photodynamic therapy (PDT) combined with intravitreal triamcinolone acetonide injection (IVTA) in patients with choroidal neovascularization (CNV) caused by age-related macular degeneration (AMD). A retrospective analysis of clinical data for 54 patients with CNV resulting from AMD was carried out. All patients had a follow-up of 12 months. The patients were treated with standardized PDT and IVTA (4 mg) as a first-line treatment or following PDT failure. Visual acuity (VA), greatest linear diameter (GLD) of the CNV and foveal thickness were evaluated. Mean VA at baseline was 0.8 logMAR (0.4-1.4). After 12 months VA improved (> 2 lines) in 20.4% of patients and stabilized (+/- 2 lines) in 64.8%. There was no statistical significance in VA outcome between patients undergoing first-line treatment and patients with PDT failure; however, fewer PDT treatments were required to stop CNV activity in patients undergoing first-line treatment. At 12 months, a reduction in foveal thickness was seen in 67.7% of patients and a reduction in CNV GLD in 32.7%. Complications occurred in 22% of patients and included a transient rise in intraocular pressure, cataract and sterile hypopyon. Our analysis shows that fewer PDT treatments were required to stop CNV activity when triamcinolone was used as first-line treatment. We can thus conclude that PDT combines synergistically with IVTA and the combination may lead to a cost reduction compared with PDT therapy alone. The overall complication rate of 22% is high and must be compared with complication rates caused by new intravitreal anti-VEGF (vascular endothelial growth factor) drugs in combination with PDT.

Photodynamic therapy of circumscribed choroidal hemangioma: comparison of dosage and timing

Abstract Purpose To compare standard versus bolus photodynamic therapy (PDT) in the treatment of symptomatic circumscribed choroidal hemangioma (CCH). Methods Twenty consecutive cases of CCH were included in this prospective randomized study. Each patient was randomly assigned to receive either standard PDT (10‐minutes 6mg/mq2 verteporfin infusion; treatment at 15 min; 50 J/cm2; 83 sec) or bolus‐PDT (6mg/mq2 verteporfin intravenously bolus in 2 min; treatment at 5 min; 100 J/cm2; 166 sec). All patients were treated with a single PDT application. Best correct visual acuity, fundus photography, optical coherence tomography, fluorescein and indocyanine green angiography were performed at baseline and at each follow‐up examination. Retinal sensitivity was tested with microperimetry after treatment. Follow‐up was longer than 24 months. Results Mean follow‐up was 28 ± 4 months. All cases (100%) showed clinical regression of the treated lesion, complete resolution of subretinal fluid and reduction of choroidal leakage on angiograms. Cases treated with bolus‐PDT showed retinal pigment epithelium (RPE) hyperplastic changes over treated area. No similar RPE changes were found in patients treated with standard PDT. Two patients treated with bolus‐PDT developed macular pucker, respectively 4 and 5 months after treatment. Microperimetry examination revealed areas of reduced sensitivity after bolus‐PDT compare to standard PDT (p&lt;0.001). Conclusion Both standard and bolus‐PDT seem effective in the treatment of symptomatic CCH. Bolus‐PDT may cause reactive retinal changes impairing retinal sensitivity, whereas standard PDT never impairs (and sometimes restores) retinal function.

Photodynamic therapy of circumscribed choroidal hemangioma: comparison of dosage and timing

Purpose To compare standard versus bolus photodynamic therapy (PDT) in the treatment of symptomatic circumscribed choroidal hemangioma (CCH). Methods Twenty consecutive cases of CCH were included in this prospective randomized study. Each patient was randomly assigned to receive either standard PDT (10-minutes 6mg/mq2 verteporfin infusion; treatment at 15 min; 50 J/cm2; 83 sec) or bolus-PDT (6mg/mq2 verteporfin intravenously bolus in 2 min; treatment at 5 min; 100 J/cm2; 166 sec). All patients were treated with a single PDT application. Best correct visual acuity, fundus photography, optical coherence tomography, fluorescein and indocyanine green angiography were performed at baseline and at each follow-up examination. Retinal sensitivity was tested with microperimetry after treatment. Follow-up was longer than 24 months. Results Mean follow-up was 28 ± 4 months. All cases (100%) showed clinical regression of the treated lesion, complete resolution of subretinal fluid and reduction of choroidal leakage on angiograms. Cases treated with bolus-PDT showed retinal pigment epithelium (RPE) hyperplastic changes over treated area. No similar RPE changes were found in patients treated with standard PDT. Two patients treated with bolus-PDT developed macular pucker, respectively 4 and 5 months after treatment. Microperimetry examination revealed areas of reduced sensitivity after bolus-PDT compare to standard PDT (p<0.001). Conclusion Both standard and bolus-PDT seem effective in the treatment of symptomatic CCH. Bolus-PDT may cause reactive retinal changes impairing retinal sensitivity, whereas standard PDT never impairs (and sometimes restores) retinal function.

OCT-Guided Photodynamic Therapy for Angiographic Occult CNV in Pathologic Myopia

Pathologic myopia (PM) is frequently complicated by choroidal neovascularization (CNV). Diagnosis is mainly clinical and angiographic but in recent years optical coherence tomography (OCT) has been noted to add important information. The authors report on the successfully OCT-guided photodynamic therapy (PDT) of an angiographic occult CNV complicating PM. Observational case report. Fluorescein angiography with a confocal SLO (HRA, Heidelberg Engineering, Germany) and OCT Stratus (Carl Zeiss Meditec, Inc.) imaging were used for diagnosis and monitoring of the CNV. Standard PDT was performed. A highly myopic 17-year-old girl complained of a drop in visual acuity (VA) in left eye (LE), dating back a few weeks. Her best-corrected (BC) VA was 20/40 in the LE, with some metamorphopsia. No hemorrhage or evident signs of CNV were visible either at fundus or at dynamic fluorescein angiography. OCT scans indicated a slight elevation of the RPE-choriocapillary complex with rarefaction of neuroretinal tissue that has been interpreted as CNV. PDT was then performed. LE BCVA had improved to 20/25, metamorphopsias disappeared, and at OCT examination no retinal morphologic modification was evident. Nine months later, BCVA and ophthalmoscopy are still stable. In this case, OCT was the fundamental tool for the correct diagnosis and posttherapymonitoring of CNV-complicated PM. The CNV, not clearly detectable using angiographic imaging, was treated with PDT, and results in terms of VA and anatomic resolution were good.

Acute Visual Loss and Chorioretinal Infarction after Photodynamic Therapy Combined with Intravitreal Triamcinolone

To report acute visual loss associated with dynamic vascular changes after photodynamic therapy (PDT) combined with intravitreal triamcinolone (IVTA) for the treatment of occult choroidal neovascularization (CNV). An 86-year-old woman complained of visual loss in her left eye. Angiographic examination showed a serous pigment epithelium detachment complicated by CNV. She underwent combined treatment with IVTA (4 mg) followed by standard verteporfin PDT administered after a 5-day interval. The patient developed vision loss 1 day after PDT. Ophthalmoscopic examination disclosed an acute serous neurosensory retinal detachment. Fluorescein angiography showed a large area of early hypofluorescence in correspondence to and extending beyond the photodynamic spot. Neurosensory retinal vessels involvement with dilation of the retinal arterioles and capillary nonperfusion were also revealed. Indocyanine green angiography showed choroidal infarction within the collateral choroid included in the area of light exposure, with associated nonperfusion of medium and large choroidal vessels being revealed. Five days after PDT, spontaneous severe bleeding with breakthrough into the vitreous occurred, in addition to an RPE tear. Acute loss of vision associated with vascular changes in retinal and choroidal circulation represents an uncommon but serious complication following combined PDT and IVTA. These risks should be carefully considered in combination therapies.

Photodynamische Therapie kombiniert mit intravitrealer Injektion von Bevacizumab zur Behandlung okkulter und klassischer choroidaler Neovaskularisationen bei AMD

The aim of this study is to discuss the effect and outcome of a combined photodynamic therapy and intravitreal injection of bevacizumab (1.25 mg) in occult and classic choroidal neovascularisation (CNV) due to AMD. Especially cases of occult CNV with pigment epithelium detachment (PED) are not likely to respond positively to standard photodynamic therapy, often ending up in PED enlargement or tearing of the RPE.In a pilot study involving 23 patients, intravitreal injections of bevacizumab were administered within 12 to 24 hours after standard PDT to reduce the post-PDT increase of proangiogenic and inflammatory factors. Before and at 1, 3 and 6 month after treatment visual acuity and OCT examinations (retinal thickness) were performed.Mean visual acuity was significantly improved compared to baseline. (VA baseline 20/125, after 1 month 20/80, after 3 months 20/80, and 20/80 after 6 months) and an enlargement of the PED in occult CNV was prevented. We found no RPE rip. OCT findings in patients with occult and classic choroidal neovascularisation 1, 3 and 6 months after combination therapy showed a reduced retinal thickness compared to baseline.Photodynamic therapy combined with injection of intravitreal bevacizumab tends to be more effective compared to PDT monotherapy by reducing the post-PDT increase of vascular growth and inflammatory factors. Our short-term results are very promising. Further studies are necessary to show the long-term effect of PDT and anti-VEGF combination therapy.

Reduced fluence versus standard photodynamic therapy in combination with intravitreal triamcinolone: short-term results of a randomised study

Background:To compare early treatment effect of reduced fluence versus standard photodynamic therapy (rPDT, sPDT, respectively) in combination with intravitreal triamcinolone (IVTA) in neovascular age-related macular degeneration.Methods:Forty patients received either sPDT...

Comparison of Multiple Reduced-dose and Standard Light Application in Photodynamic Therapy in an Animal Model of Choroidal Neovascularization

Current photodynamic therapy (PDT) for choroidal neovascularization (CNV) uses a standard radiant exposure of 50 J/cm2 at an irradiance of 600 mW/cm2. However, low-intensity PDT with verteporfin for neovascular tissue has been shown to be more effective than regular high-intensity PDT in an animal model of healthy choroids and corneal neovascularization. Low-intensity PDT also supposedly induces less retinal damage. In this study, we compared the effect of reduced-dose and standard light application PDT in an animal model of CNV. A laser injury model was used to induce CNV 3 weeks prior to PDT in brown Norway rats. The CNV lesions were then treated with verteporfin PDT with a dose of verteporfin 6.0 mg/m2 and 5 activating doses of light energy (43, 53, 63, 73 and 83 seconds). Closure of CNV was assessed by fundus fluorescein angiography (FAG). Histopathologic study was done after the last FAG. PDT with verteporfin significantly reduced the CNV area compared with control non-treated groups 1 week after PDT (p < 0.05). Only those lesions treated for 63 seconds or longer retained their significantly attenuating effect on CNV up to 3 weeks after PDT. There was no significant difference between the inhibition effects induced by reduced-intensity light application for 63 or 73 seconds compared to the standard radiant exposure (83 seconds). Histopathologic study showed that eyes treated with PDT showed significantly less extent and vascularity of CNV lesion than control lesions. Reduced-intensity PDT with 63-second duration seemed to be as effective as standard dose for CNV suppression. Considering the possible retinal damage following standard PDT, the PDT dose might be adjusted to reduce side effects. Further preclinical study will provide more data on what constitutes appropriate dosimetry for effective and safe PDT in CNV.

Intravitreal bevacizumab (Avastin) therapy versus photodynamic therapy plus intravitreal triamcinolone for neovascular age-related macular degeneration: 6-month results of a prospective, randomised, controlled clinical study

Aims:To compare functional and anatomical outcomes of intravitreal bevacizumab (Avastin) and verteporfin (photodynamic) therapy (PDT) combined with intravitreal triamcinolone (IVTA) in patients with neovascular age-related macular degeneration (AMD).Methods:Twenty-eight patients with...

Two years follow-up outcome of verteporfin therapy for subfoveal choroidal neovascularization in pathologic myopia in Indian eyes

In India, refractive errors are a major cause of treatable blindness. Population surveys in southern India have shown prevalence of high myopia to be 4.32-4.54%. Photodynamic therapy (PDT) for choroidal neovascularization (CNV) caused by pathologic myopia is beneficial. To report the 24 months outcome of PDT with verteporfin for subfoveal CNV caused by pathologic myopia in Indian eyes. Prospective case series. Review of prospectively collected data of Indian patients with pathologic myopia and subfoveal CNV treated with verteporfin therapy between 2001 and 2005 using standard regimen for PDT. Wilcoxon signed rank test was used to see the difference in the mean letter acuity at intervals compared to baseline. Kaplan Meier Survival analysis was done to estimate the success rate of verteporfin therapy for CNV caused by pathologic myopia. Fifteen patients (15 eyes) treated with standard fluence PDT and who had completed 24 months follow-up were analyzed. The mean spherical equivalent was -13.36 +/- 5.88 diopter. Five out of 15 eyes in six months, three out of 15 eyes at 12 months and four eyes out of 15 at 24 months had improved vision by > 10 letters. The mean number of treatment session was 2.2 in two years. PDT with verteporfin for subfoveal CNV caused by pathologic myopia in Indian eyes is effective.

Triamcinolone Acetonide as Adjunctive Treatment to Verteporfin in Neovascular Age-Related Macular Degeneration: A Prospective Randomized Trial

To examine the use of intravitreal triamcinolone acetonide (IVTA) as adjunctive therapy to photodynamic therapy (PDT) in the treatment of occult and minimally classic choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD). Single-center prospective randomized pilot clinical trial. Thirty eyes of 30 patients with occult or minimally classic CNV secondary to AMD. Patients were randomized prospectively to receive either PDT alone or combined PDT plus IVTA treatment for CNV secondary to AMD. Standard verteporfin PDT was performed in all patients. In the PDT plus IVTA group, a 12-mg intravitreal injection of triamcinolone acetonide was given 30 minutes after PDT. Active lesions were retreated every 3 months for 1 year. Change in visual acuity and retreatment rate. Mean visual acuity remained stable in the PDT plus IVTA group (-1.9 Early Treatment Diabetic Retinopathy Study [ETDRS] letters; P = 0.58), but declined significantly in the PDT alone group (-13.3 ETDRS letters; P = 0.02). The treatment rate was 1.13 in the PDT plus IVTA group and 3.6 in the PDT alone group (P<0.0001). Mean contrast sensitivity increased by 3.6 letters (P = 0.09) in the PDT plus IVTA group and decreased by -1.84 letters (P = 0.07) in the PDT alone group. Cataract progression was noted in 4 of 7 phakic eyes in the PDT plus IVTA group. Six patients (40%) in the combined PDT plus IVTA group required topical glaucoma therapy for control of elevated intraocular pressure. This pilot study demonstrated effective stabilization of visual acuity and reduced treatment frequency at 12 months with combination PDT plus IVTA therapy versus PDT alone. Larger randomized trials are ongoing to determine the efficacy and risks of PDT with IVTA.