Intravitreal triamcinolone combined with PDT may benefit those with exudative AMD

October 25, 2004

New Orleans-Intravitreal triamcinolone combined with photodynamic therapy (PDT) with verteporfin (Visudyne, Novartis Ophthalmics/QLT) appears to be another option for treating patients with exudative macular degeneration, according to Daniel B. Roth, MD, who spoke during the American Academy of Ophthalmology annual meeting.

Patients with subfoveal choroidal neovascularization (CNV) were treated with a 4-mg dose of intravitreal triamcinolone 1 week before PDT and then re-evaluated at 3-month intervals with fluorescein. Patients were divided into 2 groups: the salvage group 1 (42 eyes) and primary treatment group 2 (28 eyes). The salvage group had persistent leakage with significant subretinal fluid after a mean of 3.1 prior PDT sessions. The second group had not been treated before and was considered likely to respond to combined therapy based on their characteristics, noted Dr. Roth.

Mean lesion size was 5.4 mm for group 1 and 3.9 mm for group 2 and patients were followed for up to 12 months after combined therapy.

"In terms of visual acuity outcome, in group 1, 20% of eyes saw 2 lines or better at 12 months and 12% at final visit. Stabilization of vision within 2 lines or better was seen in 90% of eyes at 12 months and 88% at the final visit," Dr. Roth said.

In the second group, 13% saw 2 lines or better at 12 months and 14% at the final visit and 80% of eyes were stable within 2 lines or better at 12 months and 79% at the final visit, he continued.

Re-treatments were required in some cases with PDT alone at 3 months and triamcinolone was used with PDT every 6 months if leakage persisted. About 24% of eyes required additional triamcinolone in group 1 and 39% in group 2.

There were few complications associated with combination therapy, which included increased IOP with 13% of eyes requiring drops. Nineteen percent required cataract removal.

"Intravitreal triamcinolone may enhance the efficacy of PDT with verteporfin in treating CNV in macular degeneration," Dr. Roth said.