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Combination therapy of intravitreal triamcinolone and photodynamic therapy with verteporfin for subfoveal choroidal neovascularization
Hussain Nazimul,Das Taraprasad,Rawal Hema,Kallukuri Sumasri
Indian Journal of Ophthalmology , 2006,
Abstract: Aim: To evaluate the six months follow-up outcome of combined intravitreal triamcinolone acetonide (IVTA) and photodynamic therapy (PDT) for subfoveal choroidal neovascularization compared to PDT alone. Study design: Prospective interventional pilot study. Materials and Methods: Patients with six months follow-up of IVTA following PDT (Group I, eight eyes) and PDT alone (Group II, eight eyes) were included. Four mg/ 0.1 ml of IVTA was injected 7-10 days following PDT. The patients were reevaluated every month for the first two months and every three months thereafter in both the groups. Results: Group I: The mean age was 65.8±11.8 years (range: 47-79 years). Five patients were male. The total treatment sessions in six months were 11 (mean: 1.36). At six months, one eye had 3 10 letters gain and three eyes had > 10 letters loss. Four eyes had stable vision. Two eyes (25%) developed increased intraocular pressure (>40 mmHg) during follow-up. Group II: The mean age was 58.7±11.7 years (range: 46-76 years). Five patients were male. The total treatment sessions in six months were 17 (mean: 2.13). At six months, six eyes had 3 10 letters gain and none had > 10 letters loss. Two eyes had stable vision. Conclusion: The mean number of treatment sessions following combination therapy of IVTA (4 mg) and PDT appears relatively less (1.36 at six months) compared to PDT alone (mean: 2.13). ( P =0.02)
Verteporfin photodynamic therapy combined with intravitreal triamcinolone for choroidal neovascularization due to angioid streaks
Alfredo Pece, Gaetano Russo, Federico Ricci, et al
Clinical Ophthalmology , 2010, DOI: http://dx.doi.org/10.2147/OPTH.S10649
Abstract: teporfin photodynamic therapy combined with intravitreal triamcinolone for choroidal neovascularization due to angioid streaks Original Research (3588) Total Article Views Authors: Alfredo Pece, Gaetano Russo, Federico Ricci, et al Published Date May 2010 Volume 2010:4 Pages 525 - 530 DOI: http://dx.doi.org/10.2147/OPTH.S10649 Alfredo Pece1, Gaetano Russo2, Federico Ricci3, Vincenzo Isola1, Ugo Introini4, Giuseppe Querques5 1Department of Ophthalmology, Melegnano Hospital, Milan, Italy; 2Fondazione Evangelica Betania, Napoli, Italy; 3University of Tor Vergata, Rome, Italy; 5University, Paris XII, France; 4San Raffaele University Hospital, Milan, Italy 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.
Combination photodynamic therapy and bevacizumab for choroidal neovascularization associated with toxoplasmosis  [cached]
Rishi Pukhraj,Venkataraman Anusha,Rishi Ekta
Indian Journal of Ophthalmology , 2011,
Abstract: A 14-year-old girl presenting with visual loss in both eyes was diagnosed to have healed toxoplasma retinochoroiditis in the right eye with active choroidal neovascularization (CNV) secondary to toxoplasmosis in the left. She underwent combination photodynamic therapy (PDT) and intravitreal bevacizumab as primary treatment. PDT was performed as per the ′Treatment of Age-related Macular Degeneration by Photodynamic therapy′ study protocol and was followed by intravitreal bevacizumab after 2 days. CNV regressed at 8 weeks of follow-up and remained stable at 8 months of follow-up. The initial visual acuity improved from 20/120 to 20/30. Combination therapy with PDT and intravitreal bevacizumab appears to be effective in the treatment of CNV secondary to toxoplasma retinochoroiditis.
Verteporfin photodynamic therapy combined with intravitreal triamcinolone for choroidal neovascularization due to angioid streaks  [cached]
Alfredo Pece,Gaetano Russo,Federico Ricci,et al
Clinical Ophthalmology , 2010,
Abstract: Alfredo Pece1, Gaetano Russo2, Federico Ricci3, Vincenzo Isola1, Ugo Introini4, Giuseppe Querques51Department of Ophthalmology, Melegnano Hospital, Milan, Italy; 2Fondazione Evangelica Betania, Napoli, Italy; 3University of Tor Vergata, Rome, Italy; 5University, Paris XII, France; 4San Raffaele University Hospital, Milan, ItalyPurpose: 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
Photodynamic therapy of subfoveal choroidal neovascularization
Georgijevi? Ana,Tomi? Zoran
Srpski Arhiv za Celokupno Lekarstvo , 2007, DOI: 10.2298/sarh0712629g
Abstract: Introduction Photodynamic therapy (PDT) is a method of treatment of choroidal neovascularization (CNV) with a diode laser used after intravenously administered verteporfin. Verteporfin is a light-activated drug initiating photochemical reactions in the target tissue. This leads to the selective occlusion of blood vessels in the CNV with no damage of photoreceptors, retinal pigment epithelium and retinal blood vessels. Objective To show the results of the treatment of predominantly classic subfoveal CNV with PDT with verteporfin used for the first time in our country. Method From 2003 to 2005, we treated 15 eyes in 15 patients using PDT and verteporfin, because of predominantly classic subfoveal CNV. If macular oedema was present as proved by fluorescein angiography, triamcinolone was administered intravitreally after PDT. Average follow-up period was 7 months (3 months to 2 years). Study design: retrospective, noncomparative, consecutive case series. Results Two thirds of patients had CNV due to AMD, while in others it was caused by pathologic myopia, chorioretinitis, angioid streaks, choroidal hemangioma, except for one patient who had idiopathic CNV. Visual acuity was stabile in 60% (9/15) of patients, of whom in 60% (6/10) of patients with AMD, as well as in patients with pathologic myopia, idiopathic CNV and choroidal hemangioma. Retreatment with PDT was indicated in 40% (6/15) and in 50% (5/10) of patients with AMD, mostly 4-6 months after first PDT, but was done only in one patient (economic reasons). In two patients with AMD, triamcinolone was administered intravitreally for 2-4 months, which resulted in the stabilization of visual acuity. Conclusion Visual acuity was stabile in 60% of all treated patients with predominantly classic subfoveal CNV after only one application of PDT with verteporfin during the average follow-up of 7 months (3 months to 2 years). Retreatment was indicated in 40% of the treated patients, and in 50% of patients with AMD. As confirmed, intravitreal administration of triamcinolone after PDT could stabilize visual acuity. Side effects were not noticed.
Use of intravitreal injection of triamcinolone acetonide in the treatment of age-related macular degeneration  [cached]
Gopal Lekha,Sharma Tarun
Indian Journal of Ophthalmology , 2007,
Abstract: Age-related macular degeneration (AMD) is now considered an important and leading cause of blindness among elderly patients in developed and developing countries. AMD has two forms, dry and wet; both can lead to visual loss. However, occurrence of subfoveal choroidal neovascular (CNV) membrane in the wet form results in severe visual impairment. Treatment options for choroidal neovascularization are available in order to maintain and in some cases improve vision. Photodynamic therapy (PDT) has been used to treat both classic and occult membranes. It has known to cause choroidal hypoperfusion and production of vascular endothelial growth factor. Intravitreal steroid can possibly reduce the damage caused due to these undesirable effects. In the recent past, intravitreal injection of triamcinolone acetonide (IVTA) has been used extensively as an adjunct to PDT in AMD in order to reduce the number of PDT sessions and evaluate possible beneficial effects on vision. This article reviews the pharmacological attributes of triamcinolone, available evidence of its use as monotherapy or combination therapy to treat AMD, ocular side-effects thereof and ongoing clinical trials on IVTA.
Visual acuity and contrast sensitivity outcomes in Indian eyes undergoing photodynamic therapy with intravitreal injection of triamcinolone acetonide in age-related macular degeneration  [cached]
Kumar Atul,Sinha Subijay,Kumar Vikram
Indian Journal of Ophthalmology , 2007,
Abstract: Purpose: To evaluate photodynamic therapy (PDT) with verteporfin along with intravitreal triamcinolone acetonide (IVTA) in the treatment of neovascular age-related macular degeneration (AMD). Materials and Methods: This prospective interventional case series included 23 patients (23 eyes) of choroidal neovascularization due to neovascular AMD who were treated with PDT with verteporfin followed by an injection of 4 mg IVTA. The main outcome measures were visual acuity (VA), contrast sensitivity, retreatment frequency with PDT (and triamcinolone) and frequency of side-effects. Results: Twenty-three eyes underwent PDT with verteporfin followed by IVTA one week later. All patients were followed up for one year. Initial VA ranged from 20/32 to 20/800 and final VA ranged from 20/40 to 20/500 at the end of 12 months. VA stabilized (that is loss/gain < 2 lines) in 19 (82%) eyes. Contrast sensitivity also improved in 16/23 eyes (70%). Lesion type and patient′s age had no influence on the outcome, but baseline VA had a borderline statistically significant effect ( P =0.059). Six eyes (27%) had an increase in intraocular pressure that required therapy. There were no cases of endophthalmitis, but four eyes (18%) developed significant cataract that required surgery during the follow-up period. Conclusion : The combination of PDT along with IVTA improves contrast sensitivity and stabilizes vision during one-year follow-up.
Combined treatment of exudative age related macular degeneration with photodynamic therapy and intravitreal triamcinolone  [cached]
José Mª Ruiz-Moreno,Javier A Montero
Clinical Ophthalmology , 2008,
Abstract: José Ma Ruiz-Moreno1,2, Javier A Montero21Department of Ophthalmology, Miguel Hernández University School of Medicine, Alicante, Spain; 2Vitreo-Retinal Unit, Alicante Institute of Ophthalmology, Alicante, SpainAbstract: Choroidal neovascularization (CNV) secondary to age related macular degeneration is among the leading causes of legal blindness in developed countries. Photodynamic therapy (PDT) with verteporfin induces CNV closure causing little damage to healthy tissue, but the need to re-treat may lead to low final visual acuity at an unacceptable cost. The association of intravitreous triamcinolone or antiangiogenic drugs with PDT has been used in order to reduce these limitations of the therapy. The combination of PDT and intravitreous triamcinolone, its complications and outcome at one and two-year follow-up are discussed.Keywords: age related macular degeneration, choroidal neovascularization, photodynamic therapy, steroid, triamcinolone
Foveal atrophy and macular hole formation following intravitreal ranibizumab with/without photodynamic therapy for choroidal neovascularization secondary to age-related macular degeneration
Pukhraj Rishi, Nachiappan Kasinathan, Chinmaya Sahu
Clinical Ophthalmology , 2011, DOI: http://dx.doi.org/10.2147/OPTH.S16947
Abstract: veal atrophy and macular hole formation following intravitreal ranibizumab with/without photodynamic therapy for choroidal neovascularization secondary to age-related macular degeneration Case Series (3498) Total Article Views Authors: Pukhraj Rishi, Nachiappan Kasinathan, Chinmaya Sahu Published Date February 2011 Volume 2011:5 Pages 167 - 170 DOI: http://dx.doi.org/10.2147/OPTH.S16947 Pukhraj Rishi, Nachiappan Kasinathan, Chinmaya Sahu Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, 18 College Road, Chennai-600006. Tamil Nadu, India Background: To report the occurrence of foveal atrophy and macular hole formation following intravitreal ranibizumab with or without photodynamic therapy for choroidal neovascularization caused by age-related macular degeneration. Methods: This was a retrospective, interventional case series, in which 78 eyes of 76 patients were treated for wet age-related macular degeneration between February 2007 and August 2007. Of these, three eyes developed foveal atrophy following treatment. Two eyes underwent combination photodynamic therapy and intravitreal ranibizumab, and one eye underwent intravitreal ranibizumab alone. One of the two eyes that underwent combination therapy progressed to develop a macular hole. Results: On the first follow-up visit, all three eyes showed thinning of the fovea on optical coherence tomography. Subsequently, treatment was continued with repeat intravitreal ranibizumab injections. At the last follow-up, although choroidal neovascularization regressed in all eyes, extensive foveal atrophy developed in two eyes with macular hole formation in one eye. Conclusion: The possibility of foveal atrophy and macular hole formation must be borne in mind before initiating ranibizumab in combination with or without photodynamic therapy. However, larger studies with longer follow-up are required to understand such adverse effects better.
Foveal atrophy and macular hole formation following intravitreal ranibizumab with/without photodynamic therapy for choroidal neovascularization secondary to age-related macular degeneration  [cached]
Pukhraj Rishi,Nachiappan Kasinathan,Chinmaya Sahu
Clinical Ophthalmology , 2011,
Abstract: Pukhraj Rishi, Nachiappan Kasinathan, Chinmaya SahuShri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, 18 College Road, Chennai-600006. Tamil Nadu, IndiaBackground: To report the occurrence of foveal atrophy and macular hole formation following intravitreal ranibizumab with or without photodynamic therapy for choroidal neovascularization caused by age-related macular degeneration.Methods: This was a retrospective, interventional case series, in which 78 eyes of 76 patients were treated for wet age-related macular degeneration between February 2007 and August 2007. Of these, three eyes developed foveal atrophy following treatment. Two eyes underwent combination photodynamic therapy and intravitreal ranibizumab, and one eye underwent intravitreal ranibizumab alone. One of the two eyes that underwent combination therapy progressed to develop a macular hole.Results: On the first follow-up visit, all three eyes showed thinning of the fovea on optical coherence tomography. Subsequently, treatment was continued with repeat intravitreal ranibizumab injections. At the last follow-up, although choroidal neovascularization regressed in all eyes, extensive foveal atrophy developed in two eyes with macular hole formation in one eye.Conclusion: The possibility of foveal atrophy and macular hole formation must be borne in mind before initiating ranibizumab in combination with or without photodynamic therapy. However, larger studies with longer follow-up are required to understand such adverse effects better.Keywords: age-related macular degeneration, choroidal neovascularization, macular hole, foveal atrophy, photodynamic therapy, ranibizumab
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