Verteporfin and Intravitreal Triamcinolone Acetonide Combination Therapy for Occult Choroidal Neovascularization in Age-Related Macular Degeneration

To evaluate the efficacy and safety of photodynamic therapy (PDT) with verteporfin combined with intravitreal triamcinolone (IVTA) in occult choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD). Single center, nonrandomized interventional case series. A prospective, noncomparative, interventional case series of 41 eyes of 41 patients with a two-year follow-up period. Verteporfin PDT was performed using the recommended standard procedure for approved forms of AMD. A solution containing 25 mg of crystalline triamcinolone acetonide was injected intravitreally 16 hours post PDT. The procedure was repeated after three months in case of persistent CNV leakage. The mean number of treatments needed was 1.8. Thirty-four eyes (82.9%) required one retreatment at three months. No additional retreatments were necessary. Visual acuity improved gradually in most of the patients with mean values of 20/133 and 20/115 at baseline and three months; 20/101 and 20/84 at six and twelve months; and 20/83 and 20/81 at eighteen and twenty-four months. Eleven of 41 treated study eyes (26.8%) underwent cataract surgery between six and fifteen months after the first treatment. Nine patients required local or systemic glaucoma therapy because of a transient steroid induced intraocular pressure increase. Verteporfin PDT combined with intravitreal triamcinolone may improve the outcome of standard verteporfin PDT in the treatment of occult CNV secondary to AMD. An improvement in visual acuity was observed in most of the treated patients and was maintained during a two-year follow-up period. Retreatment numbers were lower than expected from monotherapy trials.