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Photodynamic therapy and intravitreal triamcinolone for neovascular age-related macular degeneration: a randomized clinical trial.
Ophthalmology 2009; 116(11):2149-57.e1O

Abstract

PURPOSE

To evaluate the efficacy of intravitreal triamcinolone acetonide (ITA) as an adjunct to photodynamic therapy with verteprofin (VPDT) in the treatment of predominantly classic, subfoveal choroidal neovascularization (CNV) owing to age-related macular degeneration (AMD).

DESIGN

A multicenter, 2-year, double-blind, randomized, sham-controlled trial conducted at 11 sites in Canada.

PARTICIPANTS AND CONTROLS

One hundred individuals over the age of 50 were randomized 1:1 to either to VPDT alone or combined VPDT and ITA.

INTERVENTION

Participants all received full-fluence VPDT and were randomly assigned to either (1) a same-day injection of 4 mg ITA or (2) a sham intraocular injection.

MAIN OUTCOME MEASURE

The primary end point was the change in numbers of letters read between baseline and 1 year.

RESULTS

Combination therapy with VPDT and ITA when compared with VPDT therapy alone resulted in no significant difference in final visual acuity at 1 year. Eyes treated with combination therapy lost an average of 17 letters compared with 20 letters for the VPDT group. Subjects receiving ITA required significantly fewer retreatments over the course of the study (1.28 vs 1.94, respectively; P = 0.003). Although elevated intraocular pressures were noted in a larger proportion of subjects receiving ITA, all of these individuals were managed successfully with topical ocular antihypertensive agents.

CONCLUSIONS

There was no visual benefit to the addition of intravitreal triamcinolone to VPDT. Combination therapy, however, can reduce the number of VPDT treatments required by subjects who have predominantly classic CNV owing to AMD. This reduced treatment quantity needs to be weighed against potential side effects. (ClinicalTrials.gov number, NCT00148551).

Authors+Show Affiliations

Department of Ophthalmology, The University of British Columbia, 2550 Willow St., Vancouver, BC, Canada. crtg_vancouver@hotmail.comNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19748675

Citation

Maberley, David, and Canadian Retinal Trials Group. "Photodynamic Therapy and Intravitreal Triamcinolone for Neovascular Age-related Macular Degeneration: a Randomized Clinical Trial." Ophthalmology, vol. 116, no. 11, 2009, pp. 2149-57.e1.
Maberley D, Canadian Retinal Trials Group. Photodynamic therapy and intravitreal triamcinolone for neovascular age-related macular degeneration: a randomized clinical trial. Ophthalmology. 2009;116(11):2149-57.e1.
Maberley, D. (2009). Photodynamic therapy and intravitreal triamcinolone for neovascular age-related macular degeneration: a randomized clinical trial. Ophthalmology, 116(11), pp. 2149-57.e1. doi:10.1016/j.ophtha.2009.04.032.
Maberley D, Canadian Retinal Trials Group. Photodynamic Therapy and Intravitreal Triamcinolone for Neovascular Age-related Macular Degeneration: a Randomized Clinical Trial. Ophthalmology. 2009;116(11):2149-57.e1. PubMed PMID: 19748675.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Photodynamic therapy and intravitreal triamcinolone for neovascular age-related macular degeneration: a randomized clinical trial. AU - Maberley,David, AU - ,, Y1 - 2009/09/12/ PY - 2008/10/16/received PY - 2009/04/15/revised PY - 2009/04/17/accepted PY - 2009/9/15/entrez PY - 2009/9/15/pubmed PY - 2009/11/13/medline SP - 2149 EP - 57.e1 JF - Ophthalmology JO - Ophthalmology VL - 116 IS - 11 N2 - PURPOSE: To evaluate the efficacy of intravitreal triamcinolone acetonide (ITA) as an adjunct to photodynamic therapy with verteprofin (VPDT) in the treatment of predominantly classic, subfoveal choroidal neovascularization (CNV) owing to age-related macular degeneration (AMD). DESIGN: A multicenter, 2-year, double-blind, randomized, sham-controlled trial conducted at 11 sites in Canada. PARTICIPANTS AND CONTROLS: One hundred individuals over the age of 50 were randomized 1:1 to either to VPDT alone or combined VPDT and ITA. INTERVENTION: Participants all received full-fluence VPDT and were randomly assigned to either (1) a same-day injection of 4 mg ITA or (2) a sham intraocular injection. MAIN OUTCOME MEASURE: The primary end point was the change in numbers of letters read between baseline and 1 year. RESULTS: Combination therapy with VPDT and ITA when compared with VPDT therapy alone resulted in no significant difference in final visual acuity at 1 year. Eyes treated with combination therapy lost an average of 17 letters compared with 20 letters for the VPDT group. Subjects receiving ITA required significantly fewer retreatments over the course of the study (1.28 vs 1.94, respectively; P = 0.003). Although elevated intraocular pressures were noted in a larger proportion of subjects receiving ITA, all of these individuals were managed successfully with topical ocular antihypertensive agents. CONCLUSIONS: There was no visual benefit to the addition of intravitreal triamcinolone to VPDT. Combination therapy, however, can reduce the number of VPDT treatments required by subjects who have predominantly classic CNV owing to AMD. This reduced treatment quantity needs to be weighed against potential side effects. (ClinicalTrials.gov number, NCT00148551). SN - 1549-4713 UR - https://www.unboundmedicine.com/medline/citation/19748675/Photodynamic_therapy_and_intravitreal_triamcinolone_for_neovascular_age_related_macular_degeneration:_a_randomized_clinical_trial_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0161-6420(09)00418-7 DB - PRIME DP - Unbound Medicine ER -