Combination treatment with reduced-fluence photodynamic therapy and intravitreal injection of triamcinolone for subfoveal choroidal neovascularization in macular degeneration

Purpose: To evaluate combination treatment with reduced-fluence photodynamic therapy (PDT) and intravitreal triamcinolone acetonide (IVT) injection for choroidal neovascularization (CNV) in age-related macular degeneration (AMD). Methods: This is a retrospective consecutive case series of 23 previously untreated eyes of 22 patients with subfoveal CNV secondary to AMD. Six eyes were treated with 50 J/cm(2); 8, with 40 J/cm(2); and 9, with 25 J/cm(2). PDT was immediately followed by a 4-mg IVT injection. Patients were observed for 6 months at 6-week intervals. Results: The 50 J/cm(2) subset lost a mean of 2.2 lines of Snellen visual acuity at the 6-month follow-up compared with a 1-line lost in the 40 J/cm(2) subset and a 0.9-line gain in the 25 J/cm(2) subset. In the 50 J/cm(2) subset, 60% lost <= 3 lines,of Snellen visual acuity, 33% gained >= 0 line, and 33% gained >= 3 lines. In the 40 J/cm(2) subset, 75% lost <= 3 lines of Snellen visual acuity, 50% gained >= 0 line, and 25% gained >= 3 lines. In the 25 J/cm(2) subset, 89% lost <= 3 lines of Snellen visual acuity, 56% gained >= 0 line, and 33% gained >= 3 lines. Fifty percent of the 50 J/cm(2) subset, 50% of the 40 J/cm(2) subset, and 33% of the 25 J/cm(2) subset required retreatment by 6 months. Conclusion: Although the sample in this study was small, there was a dose-response trend toward better visual outcomes and fewer treatments in the group treated with IVT injection and reduced-fluence PDT. This study along with other previously reported work suggests that studies using PDT in combination treatment for CNV should consider adding a reduced-fluence PDT arm.