Acute visual loss and chorioretinal infarction after photodynamic therapy combined with intravitreal triamcinolone.
OBJECTIVE
To report acute visual loss associated with dynamic vascular changes after photodynamic therapy (PDT) combined with intravitreal triamcinolone (IVTA) for the treatment of occult choroidal neovascularization (CNV).


METHODS
An 86-year-old woman complained of visual loss in her left eye. Angiographic examination showed a serous pigment epithelium detachment complicated by CNV. She underwent combined treatment with IVTA (4 mg) followed by standard verteporfin PDT administered after a 5-day interval.


RESULTS
The patient developed vision loss 1 day after PDT. Ophthalmoscopic examination disclosed an acute serous neurosensory retinal detachment. Fluorescein angiography showed a large area of early hypofluorescence in correspondence to and extending beyond the photodynamic spot. Neurosensory retinal vessels involvement with dilation of the retinal arterioles and capillary nonperfusion were also revealed. Indocyanine green angiography showed choroidal infarction within the collateral choroid included in the area of light exposure, with associated nonperfusion of medium and large choroidal vessels being revealed. Five days after PDT, spontaneous severe bleeding with breakthrough into the vitreous occurred, in addition to an RPE tear.


CONCLUSIONS
Acute loss of vision associated with vascular changes in retinal and choroidal circulation represents an uncommon but serious complication following combined PDT and IVTA. These risks should be carefully considered in combination therapies.
Lo Giudice
G
G
Department of Ophthalmology, Sant'Antonio Hospital, Padova, Italy. gvofta@libero.it
De Belvis
V
V
Piermarocchi
S
S
Galan
A
A
Prosdocimo
G
G
D000208:Acute Disease; D000369:Aged, 80 and over; D002829:Choroid / Q000098:blood supply*; D020256:Choroidal Neovascularization / Q000188:drug therapy / Q000209:etiology; D003131:Combined Modality Therapy; D005260:Female; D005451:Fluorescein Angiography; D005938:Glucocorticoids / Q000009:adverse effects*; D006801:Humans; D007208:Indocyanine Green; D007238:Infarction / Q000139:chemically induced* / Q000175:diagnosis; D007267:Injections; D008268:Macular Degeneration / Q000150:complications / Q000188:drug therapy; D010778:Photochemotherapy / Q000009:adverse effects*; D012163:Retinal Detachment / Q000139:chemically induced* / Q000175:diagnosis; D014222:Triamcinolone Acetonide / Q000009:adverse effects*; D014786:Vision Disorders / Q000139:chemically induced* / Q000175:diagnosis; D014822:Vitreous Body
D005938:Glucocorticoids; D014222:Triamcinolone Acetonide; D007208:Indocyanine Green