NEIL M.BRESSLERMDAuthor Affiliations: Institute of Ophthalmology and Visual Science, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark.
Why are physicians interested in combining intravitreal triamcinolone with verteporfin photodynamic therapy (PDT)? Visual outcome with verteporfin PDT is poor. Nonetheless, among patients with age-related macular degeneration (AMD) and predominantly classic or pure occult choroidal new vessels (CNVs), verteporfin PDT increases one's chance of losing fewer than 15 letters on a Bailey-Lovie eye chart by approximately 40% during a 2-year follow-up, compared with sham treatment.1,2 The Treatment of Age-Related Macular Degeneration with Photodynamic Therapy (TAP) and Verteporfin in Photodynamic Therapy (VIP) studies, both of which were randomized, placebo-controlled multicenter clinical trials, identified few treatment-related adverse events. In the TAP study, these included transient visual disturbances (in 22% vs 16% of controls), injection site complications (in 16% vs 6% of controls), transient photosensitivity reactions (in 3.5% vs 0% of controls), severe visual loss within 1 week of therapy (in 0.75% vs 0% of controls), and infusion-related back pain (in 2% vs 0% controls). In the VIP study, severe visual loss within 1 week of treatment occurred in 10 (4.4%) of 225 verteporfin-treated eyes and in none of the placebo-treated eyes. (Some visual recovery occurred in 5 patients.) Issues of cost-effectiveness will not be considered in detail, but verteporfin PDT appears to be cost-effective for patients with better levels of visual acuity, although the degree of cost-effectiveness is not clear.3,4
Zarbin M. Should Corticosteroids Be Considered as Part of the Standard Care With Photodynamic Therapy?. Arch Ophthalmol. 2006;124(4):563-571. doi:10.1001/archopht.124.4.563