Verteporfin photodynamic therapy combined with intravitreal triamcinolone for choroidal neovascularization due to angioid streaks

Abstract

Purpose: To report the visual outcome of photodynamic therapy (PDT) combined with intravitreal triamcinolone acetonide (IVTA) for choroidal neovascularization (CNV) secondary to angioid streaks (AS).

Methods: Five eyes of five consecutive patients (mean age 45 +/- 10 years) with CNV secondary to AS were treated by combination of PDT and IVTA. TA (4 mg/0.1 mL) was injected 7 days before PDT.

Results: All patients completed the 12-month follow-up. CNV was subfoveal in three cases and extrafoveal in two. Median best-corrected visual acuity (BCVA) was 0.3 LogMAR (70 letters) at baseline (range 1.3-0.1), and 0.5 LogMAR (60 letters) at the final examination (range 1.0-0.1). At 12 months, one patient had severe visual deterioration, with a loss of seven lines of VA; Two patients lost up to three lines. One patient had no change in BCVA and the fifth gained nine lines of VA. Two patients received one further combination of PDT and IVTA after the first combination treatment. All eyes showed the CNV closure at the 12-month follow-up visit.

Conclusions: Combination of PDT and IVTA may reduce the need for retreatment and could be potentially useful for preserving vision in some patients with CNV due to AS.

Keywords: ocular corticosteroids.

Figure 1

Left eye of patient 2. Black and white red-free photo A) shows peripapillary subretinal hemorrhages, and fluorescein angiography (FA) B) reveals the leakage from the neovascular complex (papillomacular region, and nasal to the optic disc), before receiving PDT/IVTA (best-corrected visual acuity 20/32 [0.2 LogMAR]). Twelve months after the 1st combined treatment (6 months after the 2nd combined treatment), best-corrected visual acuity was 20/63 (0.5 LogMAR), the red-free photo C) shows absorption of blood, and FA D) discloses a decrease in fluorescein leakage after regression of choroidal neovascularization. Abbreviations: IVTA, intravitreal triamcinolone acetonide; PDT, photodynamic, therapy.

Figure 2

Left eye of patient 4. Fluorescein angiography A) before receiving PDT/IVTA (best-corrected visual acuity 20/200 [1 LogMAR]). FA B) shows reduction of fluorescein leakage and decrease in size of choroidal neovascularization 1 year after PDT/IVTA. Best-corrected visual acuity was unchanged. Abbreviations: IVTA, intravitreal triamcinolone acetonide; PDT, photodynamic, therapy.

Figure 3

Right eye of patient 5. Color photo A) shows angioid streaks and subfoveal hemorrhages. Fluorescein angiography B) demonstrates the presence of choroidal neovascularization (CNV), and optical coherence tomography (OCT) C) reveals the neovascular complex as a high-reflective, red-yellow band in the subretinal space above the RPE/choriocapillaris layer, causing intra e subretinal exudation. Best-corrected visual acuity 20/400 [1.3 LogMAR]). Three months after PDT/IVTA: color photo D), fundus autofluorescence E), and OCT F) demonstrate restoration of foveal anatomy. Best-corrected visual acuity improved to 20/80 (0.6 LogMAR). One year after PDT/IVTA: color photo G), fundus autofluorescence H), and OCT I) show involution of CNV surrounded by some atrophic changes, and absence of blood and subretinal fluid. Best-corrected visual acuity was 20/50 (0.4 LogMAR). Abbreviations: IVTA, intravitreal triamcinolone acetonide; RPE, retinal pigment epithelium; PDT, photodynamic, therapy.