Frontiers of Medicine in China

, Volume 1, Issue 4, pp 405–409 | Cite as

Photodynamic therapy combined with intravitreal injection of triamcinolone acetonide for choroidal neovascularization

Research Article
First Online:

Abstract

The aim of this research was to evaluate the efficacy and safety of photodynamic therapy (PDT) combined with intravitreal injection of triamcinolone acetonide (TA) in the treatment of choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD) and pathological myopia. PDT combined with intravitreal injection of TA was performed on 16 eyes of 16 patients with CNV diagnosed by visual acuity, fluorescein fundus angiography (FFA) and optical coherent tomography (OCT), including 14 eyes secondary to age-related macular degeneration and two eyes secondary to pathological myopia. TA was injected intravitreally 72 h post PDT on 12 eyes and from three months to one year (mean nine months) post PDT on four eyes respectively. All the patients were followed up for 3 to 18 months (mean 18.6 months). Best-corrected visual acuity, intraocular pressure, retinal thickness and FFA were observed. The visual acuity was improved in seven eyes (43.8%) of all the 16 eyes and stable in nine eyes (56.2%), respectively. FFA revealed complete or partial closure of CNV in all patients. OCT showed that the macular edema disappeared or was alleviated. Transient intraocular pressure elevation occurred in one patient (6.25%) of all the 16 eyes and intraocular pressure returned to the normal after a transient treatment with antiglaucoma medication. The mean number of PDTs during the first year was 1.1. PDT combined with intravitreal injection of TA for CNV is safe and effective. It can reduce the risk of visual loss and the treatment frequency.

Keywords

macular degeneration photochemotherapy choroidal neovascularization triamcinolone acetonide 
This is a preview of subscription content, log in to check access.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Schmidt-Erfurth U, Michels S, Barbazetto I, Laqua H. Photodynamic effects on choroidal neovascularization and physiological choroids. Invest Ophthalmol Vis Sci, 2002, 43(3): 830–841PubMedGoogle Scholar
  2. 2.
    Zhang M X, Lu F, Yan M, Zhang J J, Meng D, Du C F, Shen Q, Wang S Q, Liao J Y. Four-year clinical summarization of photodynamic therapy for age-related macular degeneration. Zhonghua Yan Di Bing Za Zhi, 2004, 20(5): 275–279 (in Chinese)Google Scholar
  3. 3.
    Xia Q, Lu Y Y, Yu X B, Long L, Li J, Dai H. Visual function before and after photodynamic therapy of subfoveal horoidal neovascularization in age-related macular degeneration. Zhonghua Yan Di Bing Za Zhi, 2004, 20(5): 289–291 (in Chinese)Google Scholar
  4. 4.
    Schmidt-Erfurth U, Schlötzer-Schrehard U, Cursiefen C, Michels S, Beckendorf A, Naumann G O. Influence of photodynamic therapy on expression of vascular endothelial growth factor (VEGF). VEGF receptor 3, and pigment epithelium-derived factor. Invest Ophthalmol Vis Sci, 2003, 44(10): 4,473–4,480CrossRefGoogle Scholar
  5. 5.
    Rogers A H, Martidis A, Greenberg P B, Puliafito C A. Optical coherence tomography findings following photodynamic therapy of choroidal neovascularization. Am J Ophthalmol, 2002, 134(4): 566–576PubMedCrossRefGoogle Scholar
  6. 6.
    Treatment of Age-Related Macular Degeneration with Photodynamic Therapy (TAP) Study Group. Photodynamic therapy of subfoveal choroidal neovascularization in age-related macular degeneration with verteporfin: One-year results of two randomized clinical trials—TAP report 1. Arch Ophthalmol, 1999, 117(10): 1,329–1,345CrossRefGoogle Scholar
  7. 7.
    Verteporfin in Photodynamic Therapy Study Group. Verteporfin therapy of subfoveal choroidal neovascularization in age-related macular degeneration: Two-year results of a randomized clinical trial including lesions with occult with no classic choroidal neovascularization—Verteporfin in photodynamic therapy Report 2. Am J Ophthalmol, 2001, 131(5): 541–560CrossRefGoogle Scholar
  8. 8.
    Treatment of Age-Related Macular Degeneration with Photodynamic Therapy (TAP) Study Group, Verteporfin in Photodynamic Therapy Study Group. Effect of lesion size, visual acuity, and lesion composition on visual acuity change with and without verteporfin therapy for choroidal neovascularization secondary to age-related macular degeneration: TAP and VIP report no. 1. Am J Ophthalmol, 2003, 136(3): 407–418CrossRefGoogle Scholar
  9. 9.
    Martidis A, Duker J S, Greenberg P B, Rogers A H, Puliafito CA, Reichel E, Baumal C. Intravitreal triamcinolone for refractory diabetic macular edema. Ophthalmology, 2002, 109(5): 920–927PubMedCrossRefGoogle Scholar
  10. 10.
    Greenberg P B, Martidis A, Rogers A H, Duker J S, Reichel E. Intravitreal triamcinolone for macular edema due to central retinal vein occlusion. Br J Ophthalmol, 2002, 86(2): 247–248PubMedCentralPubMedCrossRefGoogle Scholar
  11. 11.
    Yu X B, Shi Z A, Dai H, Long L. Intravitreal triamcinolone acetonide for the treatment of macular edema associated with branch retinal vein occlusion. Zhongguo Shi Yong Yan Ke Za Zhi, 2006, 24(10): 1,043–1,045 (in Chinese)Google Scholar
  12. 12.
    Chang Q, Wang W J. Intravitreous injection with triamcinolone acetonide for macular edema. Zhonghua Yan Di Bing Za Zhi, 2005, 21(4): 209–212 (in Chinese)Google Scholar
  13. 13.
    Jonas J B. Intravitreal triamcinolone acetonide for treatment of intraocular oedematous and neovascular diseases. Acta Ophthalmol Scand, 2005, 83(6): 645–663PubMedCrossRefGoogle Scholar
  14. 14.
    Das-Bhaumik R G, Jones N P. Low-dose intraocular triamcinolone injection for intractable macular oedema and inflammation in patients with uveitis. Eye, 2006, 20(8): 934–937PubMedCrossRefGoogle Scholar
  15. 15.
    Jonas J B, Kreissig I, Hugger P, Sauder G, Panda-Jonas S, Degenring R. Intravitreal triamcinolone acetonide for exudative age related macular degeneration. Br J Ophthalmol, 2003, 87(4): 462–468PubMedCentralPubMedCrossRefGoogle Scholar
  16. 16.
    Danis R P, Ciulla T A, Pratt L M, Anliker W. Intravitreal triamcinolone in exudative age-related macular degeneration. Retina, 2000, 20(3): 244–250PubMedCrossRefGoogle Scholar
  17. 17.
    Ranson N T, Danis R P, Ciulla T A, Pratt L. Intravitreal triamcinolone in subfoveal recurrence of choroidal neovascularization after laser treatment in macular degeneration. Br J Ophthalmol, 2002, 86(5): 527–529PubMedCentralPubMedCrossRefGoogle Scholar
  18. 18.
    Augustin A J, Schmidt-Erfurth U. Verteporfin and intravitreal triamcinolone acetonide combination therapy for occult choroidal neovascularization in age-related macular degeneration. Am J Ophthalmol, 2006, 141(4): 638–645PubMedCrossRefGoogle Scholar
  19. 19.
    Augustin A J, Schmidt-Erfurth U. Verteporfin therapy combined intravitreal triamcinolone in all types of choroidal neovascularization due to age-related macular degeneration. Ophthalmology, 2006, 113(1): 14–22PubMedCrossRefGoogle Scholar
  20. 20.
    Gollnick S O, Evans S S, Baumann H, Owezarczak B, Maier P, Vaughan L, Wang W C, Unger E, Henderson B W. Role of cytokines in photodynamic therapy-induced local and system inflammation. Br J Cancer, 2003, 88(11): 1,772–1,779CrossRefGoogle Scholar
  21. 21.
    Schmidt-Erfurth U, Laqua H, Schlőtzer-Schrehard U, Viestenz A, Naumann G O. Histopathological changes following photodynamic therapy in human eyes. Arch Ophthalmol, 2002, 120(6): 835–844PubMedGoogle Scholar
  22. 22.
    Penfold P L, Wen L, Madigan M C, Gillies M C, King N J, Provis J M. Triamicinolone acetonide modulates permeability and intercellular adhesion molecule-1 (ICAM-1) expression of the EV304 cell line: Implications for molecular degeneration. Clin Exp Immunol, 2000, 121(3): 458–465PubMedCentralPubMedCrossRefGoogle Scholar
  23. 23.
    Penfold P L, Wong J G, Gyory J, Billson F A. Effects of triamicinolone acetonide on microglial morphology and quantitative expression of MHC-II in exudative AMD. Clin Exp Ophthalmol, 2001, 29(3): 188–192CrossRefGoogle Scholar
  24. 24.
    Jonas J B, Kreissig I, Degenering R. Repeated intravitreal injections of triamcinolone acetonide as treatment of progressive agerelated macular degeneration. Graefes Arch Clin Exp Ophthalmol, 2002, 240(10): 873–874PubMedCrossRefGoogle Scholar
  25. 25.
    Spaide R F, Sorenson J, Maranan L. Photodynamic therapy with verteporfin combined with intravitreal injection of triamcinolone acetonide for choroidal neovascularization. Ophthalmology, 2005, 112(2): 301–304PubMedCrossRefGoogle Scholar

Copyright information

© Higher Education Press and Springer-Verlag 2007

Authors and Affiliations

  • Yu Xiaobing 
    • 1
  • Dai Hong 
    • 1
  • Lu Yingyi 
    • 1
  • Long Li 
    • 1
  1. 1.Department of OphthalmologyBeijing HospitalBeijingChina

Personalised recommendations