Outcomes after combination photodynamic therapy and immunosuppression for inflammatory subfoveal choroidal neovascularisation

Aim: To report the visual and angiographic outcomes after combination photodynamic therapy ( PDT) and immunosuppression for inflammatory subfoveal choroidal neovascularisation ( CNV). Methods: Retrospective review of six consecutive patients, five female and one male, aged 23 - 40 years with active subfoveal CNV secondary to posterior uveitis. Patients received either intravitreal triamcinolone or systemic immunosuppression ( mycophenolate mofetil, tacrolimus) and PDT. Five patients had intravitreal triamcinolone injections and two patients were on systemic immunosuppression; all patients underwent PDT ( mean two treatments). Visual acuity was measured on a 2 metre ETDRS chart and fluorescein angiograms were performed at each visit. Results: Median follow up was 15 months ( range 10 - 31). Vision improved by a median of 13 letters in five patients and remained stable ( +/- 1 letter) in one patient. Median visual acuity improved from 20/ 160 at presentation to 20/ 40 at latest follow up ( p = 0.03). There was a reduction in clinical exudation and cessation of angiographic leakage in all six patients. All interventions were well tolerated. Conclusion: Combination PDT and immunosuppression may be a useful therapeutic option for young patients with active inflammatory subfoveal CNV.