Effect of posterior juxtascleral triamcinolone acetonide on choroidal neovascular growth after photodynamic therapy with verteporfin.

摘要

OBJECTIVE: To assess if posterior juxtascleral application of 40 mg triamcinolone acetonide (TA), given at the same time as initial photodynamic therapy (PDT) for predominantly classic choroidal neovascularization (CNV) related to age-related macular degeneration affects lesion growth at 3 and 6 months. DESIGN: Comparative (nonrandomized) interventional study. PARTICIPANTS: The study group consists of 38 eyes of 38 patients. The control group consists of 73 eyes of 73 patients. METHODS: Comparison of 2 consecutive case series collected at different times. The study group had a posterior juxtascleral TA with their initial PDT treatment. The controls were treated with PDT alone. All patients were reviewed at 1, 3, and 6 months. MAIN OUTCOME MEASURES: Change in total lesion size; secondary outcomes: area of leak, best-corrected visual acuity, number of treatments, and intraocular pressure. RESULTS: There was significantly less growth of total lesion at 3 months (mean difference = 2.47 mm2; 95% confidence interval (CI): +1.22 to +3.72 mm2; P = 0.0002) and 6 months (mean difference = 2.88 mm2; 95% CI: +0.61 to +5.15 mm2; P = 0.0134) in patients given TA with PDT compared with PDT alone. There was also a significantly smaller residual area of leak at 3 months in the study group (mean difference = 1.07 mm2; 95% CI: +0.16 to +1.97 mm2; P = 0.02). At 6 months, the residual area of leak between the 2 groups became comparable (mean difference = 0.13 mm2; 95% CI -1.59 to +1.33 mm2; P logarithm of the minimum angle of resolution chart at 6 months was 9.1 letters (standard error of the mean [SEM] = 2.21) in the study group compared with 12.4 letters (SEM = 1.91) in the control group (P = 0.30). At 6 months, 10 of 36 eyes (27.8%) in the study group showed > or =15 letters loss, compared with 29 of 73 eyes (39.7%) in the control group. Intraocular pressure was raised in 4 of 38 eyes (10.5%). Fewer retreatments were required in the TA with PDT group (2.03 compared with 2.47 [P = 0.006]). CONCLUSIONS: Posterior juxtascleralplacement of TA with PDT at baseline significantly reduces CNV growth at 3 and 6 months. Fewer retreatments were required. Visual outcome may be improved, although we did not show a statistically significant improvement with this sample size. A larger, randomized trial with longer follow-up is justified.