title: Combined photodynamic therapy and intravitreal triamcinolone for neovascular age-related macular degeneration: effect of initial visual acuity on treatment response.
abstract: OBJECTIVE
  To evaluate visual outcomes in combination therapy with photodynamic therapy (PDT) and intravitreal triamcinolone acetonide (IVTA) for subfoveal choroidal neovascularization (CNV) from age-related macular degeneration (AMD).
  
  
  METHODS
  Charts of 39 eyes from 38 patients with exudative AMD treated with PDT and 4 mg of triamcinolone acetate injected intravitreally were reviewed retrospectively. Visual data, angiographic lesion type, prior PDT exposure, number of treatments, and follow-up were recorded. Snellen visual acuities were converted to LogMAR for all calculations. Lines of vision lost or gained pertain to calculated ETDRS lines of vision (via LogMAR).
  
  
  RESULTS
  Twenty-two of the choroidal neovascular membranes were occult, and 17 were classified as predominantly classic. Mean follow-up was 43 weeks. The average number of treatments was 2.23. At final follow-up, 11 eyes (28.21%) experienced improved visual acuity, 8 eyes (20.51%) were stable, and 20 eyes (51.28%) had worsened. No significant difference in treatment response was found between angiographic subtypes (p > 0.59). Lack of previous PDT exposure did not improve treatment outcomes (p > 0.77). Pre-treatment visual acuity (PTVA) was determined as a strong predictor of treatment outcome in our study cohort. Visual acuity of 20/200 or worse was associated with a 40.9% chance of some improvement and a 35.75% chance of three or more lines of improvement. Visual acuity better than 20/200 was associated with an 89.4% chance of no improvement and a 58.8% chance of three or more lines of visual loss.
  
  
  CONCLUSIONS
  Counter to previously reported results with combination therapy, the majority of our patients (72%) did not demonstrate improved vision and 51% lost vision. When PTVA was accounted for, selected patients benefitted significantly from treatment. PTVA may be a useful and simple patient selection tool for combination treatment with PDT and IVTA.
authors.affiliation: Department of Ophthalmology and Visual Sciences, Washington University in St. Louis School of Medicine, Barnes Retina Institute, St. Louis, MO 63110, USA.
authors.forename: Ramin
authors.initials: R
authors.lastname: Schadlu
authors.forename: Steven M
authors.initials: SM
authors.lastname: Kymes
authors.forename: Rajendra S
authors.initials: RS
authors.lastname: Apte
mesh_terms: D020256:Choroidal Neovascularization / Q000188:drug therapy* / Q000503:physiopathology; D003131:Combined Modality Therapy; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D007267:Injections; D008268:Macular Degeneration / Q000188:drug therapy* / Q000503:physiopathology; D010778:Photochemotherapy; D017319:Photosensitizing Agents / Q000627:therapeutic use; D011166:Porphyrins / Q000627:therapeutic use; D012189:Retrospective Studies; D016896:Treatment Outcome; D014222:Triamcinolone Acetonide / Q000627:therapeutic use*; D000077362:Verteporfin; D014792:Visual Acuity / Q000187:drug effects* / Q000502:physiology; D014822:Vitreous Body
chemical_list: D005938:Glucocorticoids; D017319:Photosensitizing Agents; D011166:Porphyrins; D000077362:Verteporfin; D014222:Triamcinolone Acetonide