Combination of photodynamic therapy and intraocular triamcinolone for exudative age-related macular degeneration and long-term chorioretinal macular atrophy

Objective: To evaluate the long-term effect of intravitreal triamcinolone acetonide (IVT) treatment combined with photodynamic therapy (PDT) vs PDT alone for neovascular age related macular degeneration. Methods: Prospective randomized study. Eighty-four patients were enrolled to receive PDT (n=41) or IVT treatment followed by PDT (n =43) within approximately a 7- to 15-day interval. All patients were naive to treatment. At baseline and each follow-up visit at 3,6,12, and 24 months, measurement of best-corrected visual acuity (VA), fluorescein angiography, indocyanine green angiography, and optical coherence tomography were performed. Mean changes in VA and retreatment rate were considered as primary outcome indicators. Analysis of vascular choroidal changes documented by indocyanine green angiography and fundus antofluoresence measurements were also performed. Results: Mean VA increased at 1 month of follow-up but decreased progressively by the 24-month point in both groups (P=.74). The retreatment rate was significantly lower (P<.001) in the combined therapy group. Choroidal hypoperfusion/nonperfusion (P<.00.1) and areas with decreascd/absent fundus autofluorescence within the PDT spot area were significantly greater with combined therapy (P<.001). Conclusions: Combination IVT treatment with PDT seemed to be more effective for managing neovascular age-related macular degeneration, but long-term analysis failed to demonstrate functional benefits.