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Triamcinolone acetonide as adjunctive treatment to verteporfin in neovascular age-related macular degeneration: a prospective randomized trial.

Abstract

PURPOSE

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).

DESIGN

Single-center prospective randomized pilot clinical trial.

PARTICIPANTS

Thirty eyes of 30 patients with occult or minimally classic CNV secondary to AMD.

METHODS

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.

MAIN OUTCOME MEASURES

Change in visual acuity and retreatment rate.

RESULTS

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.

CONCLUSIONS

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.

Links

  • Publisher Full Text
  • Authors+Show Affiliations

    ,

    Ivey Eye Institute, University of Western Ontario, London, Canada. vchaudha@uwo.ca

    , ,

    Source

    Ophthalmology 114:12 2007 Dec pg 2183-9

    MeSH

    Aged
    Aged, 80 and over
    Cataract
    Chemotherapy, Adjuvant
    Choroidal Neovascularization
    Contrast Sensitivity
    Female
    Glucocorticoids
    Humans
    Injections
    Intraocular Pressure
    Macular Degeneration
    Male
    Photochemotherapy
    Photosensitizing Agents
    Pilot Projects
    Porphyrins
    Prospective Studies
    Retina
    Retreatment
    Tomography, Optical Coherence
    Triamcinolone Acetonide
    Verteporfin
    Visual Acuity
    Vitreous Body

    Pub Type(s)

    Journal Article
    Randomized Controlled Trial

    Language

    eng

    PubMed ID

    18054638

    Citation

    Chaudhary, Varun, et al. "Triamcinolone Acetonide as Adjunctive Treatment to Verteporfin in Neovascular Age-related Macular Degeneration: a Prospective Randomized Trial." Ophthalmology, vol. 114, no. 12, 2007, pp. 2183-9.
    Chaudhary V, Mao A, Hooper PL, et al. Triamcinolone acetonide as adjunctive treatment to verteporfin in neovascular age-related macular degeneration: a prospective randomized trial. Ophthalmology. 2007;114(12):2183-9.
    Chaudhary, V., Mao, A., Hooper, P. L., & Sheidow, T. G. (2007). Triamcinolone acetonide as adjunctive treatment to verteporfin in neovascular age-related macular degeneration: a prospective randomized trial. Ophthalmology, 114(12), pp. 2183-9.
    Chaudhary V, et al. Triamcinolone Acetonide as Adjunctive Treatment to Verteporfin in Neovascular Age-related Macular Degeneration: a Prospective Randomized Trial. Ophthalmology. 2007;114(12):2183-9. PubMed PMID: 18054638.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Triamcinolone acetonide as adjunctive treatment to verteporfin in neovascular age-related macular degeneration: a prospective randomized trial. AU - Chaudhary,Varun, AU - Mao,Alex, AU - Hooper,Philip L, AU - Sheidow,Tom G, PY - 2006/06/28/received PY - 2007/02/12/revised PY - 2007/02/12/accepted PY - 2007/12/7/pubmed PY - 2007/12/19/medline PY - 2007/12/7/entrez SP - 2183 EP - 9 JF - Ophthalmology JO - Ophthalmology VL - 114 IS - 12 N2 - PURPOSE: 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). DESIGN: Single-center prospective randomized pilot clinical trial. PARTICIPANTS: Thirty eyes of 30 patients with occult or minimally classic CNV secondary to AMD. METHODS: 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. MAIN OUTCOME MEASURES: Change in visual acuity and retreatment rate. RESULTS: 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. CONCLUSIONS: 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. SN - 1549-4713 UR - https://www.unboundmedicine.com/medline/citation/18054638/Triamcinolone_acetonide_as_adjunctive_treatment_to_verteporfin_in_neovascular_age_related_macular_degeneration:_a_prospective_randomized_trial_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0161-6420(07)00184-4 DB - PRIME DP - Unbound Medicine ER -