Periocular triamcinolone and photodynamic therapy for subfoveal choroidal neovascularization in age-related macular degeneration.
OBJECTIVE
To evaluate fluorescein angiographic and visual acuity (VA) outcomes from patients enrolled in a trial of a single periocular corticosteroid injection immediately before photodynamic therapy (PDT) versus PDT alone for subfoveal choroidal neovascularization secondary to age-related macular degeneration (AMD).


METHODS
Randomized 2-center clinical trial.


METHODS
Sixty-seven subjects with AMD, subfoveal choroidal neovascularization, and best-corrected VA of 20/20 to 20/320 in the study eye who had received no more than 1 prior PDT treatment.


METHODS
Subjects were randomized to receive PDT alone (no corticosteroid) or a single periocular corticosteroid injection given via the posterior superior sub-Tenon's capsule route before PDT (corticosteroid) and assessed 1, 3, and 6 months after enrollment. Best-corrected VA and intraocular pressure (IOP) measurements were taken during each examination. Color photographs and fluorescein angiograms were taken at baseline and 3 and 6 months.


METHODS
Presence or absence of fluorescein leakage from choroidal neovascularization 3 months after randomization.


RESULTS
Between the 34 participants randomized to periocular corticosteroid and 33 to no corticosteroid, baseline features appeared balanced. Thirty-three corticosteroid participants and 30 no corticosteroid participants returned for the 3-month follow-up, at which time 56 had fluorescein leakage. Proportions of participants with leakage at 3 months for the 2 treatment groups did not statistically significantly differ; 94% of the corticosteroid group and 90% of the no corticosteroid group had fluorescein leakage at 3 months (P = 0.66). Mean VAs at 3 months after enrollment were 20/100 and 20/125 in the corticosteroid and no corticosteroid groups, respectively, decreasing on average 1.5 and 0.9 lines from baseline (P = 0.50). Adverse events included IOP > 21 mmHg in 7 corticosteroid participants (21%) and 1 (3%) no corticosteroid participant (P<0.05) and ptosis of the study eyelid in 1 (3%) corticosteroid participant.


CONCLUSIONS
In contrast to previously reported uncontrolled studies and 1 controlled study, this trial did not find a reduction in the amount of fluorescein leakage 3 months after a single periocular injection of corticosteroid and PDT compared with PDT alone.
Johns Hopkins University, Baltimore, Maryland, USA.
Gilson
Marta M
MM
Bressler
Neil M
NM
Jabs
Douglas A
DA
Solomon
Sharon D
SD
Thorne
Jennifer E
JE
Wilson
David J
DJ
D000368:Aged; D002199:Capillary Permeability; D020256:Choroidal Neovascularization / Q000188:drug therapy* / Q000209:etiology / Q000378:metabolism; D005260:Female; D019793:Fluorescein / Q000378:metabolism; D005451:Fluorescein Angiography; D005456:Fluorescent Dyes / Q000378:metabolism; D005584:Fovea Centralis; D005938:Glucocorticoids / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007267:Injections; D007429:Intraocular Pressure; D008268:Macular Degeneration / Q000150:complications / Q000188:drug therapy* / Q000378:metabolism; D008297:Male; D010778:Photochemotherapy; D017319:Photosensitizing Agents / Q000009:adverse effects / Q000627:therapeutic use; D011166:Porphyrins / Q000009:adverse effects / Q000627:therapeutic use; D014222:Triamcinolone Acetonide / Q000009:adverse effects / Q000627:therapeutic use*; D000077362:Verteporfin; D014792:Visual Acuity; D014822:Vitreous Body