Combined photodynamic therapy and intravitreal triamcinolone for neovascular age-related macular degeneration: effect of initial visual acuity on treatment response.
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.
Schadlu
Ramin
R
Department of Ophthalmology and Visual Sciences, Washington University in St. Louis School of Medicine, Barnes Retina Institute, St. Louis, MO 63110, USA.
Kymes
Steven M
SM
Apte
Rajendra S
RS
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
D005938:Glucocorticoids; D017319:Photosensitizing Agents; D011166:Porphyrins; D000077362:Verteporfin; D014222:Triamcinolone Acetonide