Changes in macular sensitivity after reduced fluence photodynamic therapy combined with intravitreal triamcinolone.
OBJECTIVE
This study aimed to evaluate the course of macular sensitivity (MS) following treatment with reduced fluence photodynamic therapy (RPDT) versus standard photodynamic therapy (SPDT) in combination with intravitreal triamcinolone acetonide (IVTA) in patients with neovascular age-related macular degeneration, and to investigate the correlation between MS and angiographic outcomes.


METHODS
Forty eyes in 40 patients were included in this prospective, randomized clinical study. Group 1 patients received RPDT (n = 20, light dose of 25 J/cm(2) at 300 mW/cm(2)); group 2 patients received SPDT (n = 20, light dose of 50 J/cm(2) at 600 mW/cm(2)). All patients received 4 mg IVTA administered on the same day as RPDT or SPDT. Microperimetry, visual acuity testing (ETDRS) and fluorescein angiography (FA) were performed at baseline, and at months 3, 6, 9 and 12. Main outcome parameters were mean differential light threshold (DLT), and absolute and relative scotoma size.


RESULTS
Mean DLT decreased from 4.71 dB at baseline to 3.45 dB after 12 months in the SPDT + IVTA group (mean decrease 1.26 dB; p > 0.05) and from 5.42 dB to 4.92 dB in the RPDT + IVTA group (mean decrease 0.5 dB; p > 0.05). Absolute and relative scotoma sizes remained stable in both groups at 12 months (mean change 0 and -0.6 test-points; p > 0.05). Mean DLT values and absolute scotoma sizes correlated well with early and late leakage areas in FA (r = -0.45 to -0.80, p < 0.02).


CONCLUSIONS
With regard to MS, RPDT + IVTA did not show significant benefits over SPDT + IVTA at 12 months. Macular sensitivity correlated well with angiographic outcomes.
Department of Ophthalmology and Optometry, Medical University of Vienna, Austria.
Roman
R
Dunavoelgyi
Stefan
S
Sacu
Christian
C
Simader
Christian
C
Pruente
Ursula
U
Schmidt-Erfurth
D000368:Aged; D000369:Aged, 80 and over; D020256:Choroidal Neovascularization / Q000188:drug therapy* / Q000503:physiopathology; D003131:Combined Modality Therapy; D015350:Contrast Sensitivity / Q000502:physiology*; D004311:Double-Blind Method; D005451:Fluorescein Angiography; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D058449:Intravitreal Injections; D008268:Macular Degeneration / Q000188:drug therapy* / Q000503:physiopathology; D008875:Middle Aged; D010778:Photochemotherapy; D017319:Photosensitizing Agents / Q000627:therapeutic use; D010865:Pilot Projects; D011166:Porphyrins / Q000627:therapeutic use; D011446:Prospective Studies; D012160:Retina / Q000503:physiopathology*; D016896:Treatment Outcome; D014222:Triamcinolone Acetonide / Q000008:administration & dosage*; D000077362:Verteporfin; D014792:Visual Acuity / Q000502:physiology; D058609:Visual Field Tests
D005938:Glucocorticoids; D017319:Photosensitizing Agents; D011166:Porphyrins; D000077362:Verteporfin; D014222:Triamcinolone Acetonide