title: Profound choroidal hypoperfusion after combined photodynamic therapy and intravitreal triamcinolone acetonide.
abstract: OBJECTIVE
  To report a case series of patients with profound choroidal hypoperfusion on fluorescein angiography following combined photodynamic therapy (PDT) and intravitreal triamcinolone acetonide (IVT) for age-related macular degeneration.
  
  
  METHODS
  A retrospective chart review was performed of all 108 patients (155 treatments) who had combined PDT/IVT between January 2002 and December 2004 at the institution.
  
  
  RESULTS
  Fifteen patients were identified with "profound choroidal hypoperfusion." There were no common risk factors identified. Hypoperfusion occurred in some patients after their initial treatment, whereas in others it developed only after repeated treatments. Two patients had severe vision loss associated with profound choroidal hypoperfusion.
  
  
  CONCLUSIONS
  Profound choroidal hypoperfusion can be seen after combined therapy with PDT/ IVT. Although adding triamcinolone acetonide to PDT may improve efficacy, it may also change the side effect profile and severe vision loss may occur. Changes in treatment parameters may improve combined therapy.
authors.affiliation: Vitreoretinal Surgery, Department of Ophthalmology, Lahey Clinic, Peabody, Massachusetts 01960, USA.
authors.forename: Gregory R
authors.initials: GR
authors.lastname: Blaha
authors.forename: F Denton
authors.initials: FD
authors.lastname: Wertz
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Marx
mesh_terms: D000369:Aged, 80 and over; D002829:Choroid / Q000098:blood supply*; D020256:Choroidal Neovascularization / Q000188:drug therapy* / Q000209:etiology; D004359:Drug Therapy, Combination; D005260:Female; D005451:Fluorescein Angiography; D005938:Glucocorticoids / Q000009:adverse effects*; D006801:Humans; D007267:Injections; D008268:Macular Degeneration / Q000150:complications / Q000188:drug therapy; D008297:Male; D016491:Peripheral Vascular Diseases / Q000209:etiology* / Q000503:physiopathology; D010778:Photochemotherapy / Q000009:adverse effects*; D017319:Photosensitizing Agents / Q000009:adverse effects; D011166:Porphyrins / Q000009:adverse effects; D012039:Regional Blood Flow / Q000502:physiology; D012189:Retrospective Studies; D012307:Risk Factors; D014222:Triamcinolone Acetonide / Q000009:adverse effects*; D000077362:Verteporfin; D014792:Visual Acuity; D014822:Vitreous Body
chemical_list: D005938:Glucocorticoids; D017319:Photosensitizing Agents; D011166:Porphyrins; D000077362:Verteporfin; D014222:Triamcinolone Acetonide