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April 2006

Should Corticosteroids Be Considered as Part of the Standard Care With Photodynamic Therapy?

Author Affiliations

NEIL M.BRESSLERMDAuthor Affiliations: Institute of Ophthalmology and Visual Science, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark.

Arch Ophthalmol. 2006;124(4):563-571. doi:10.1001/archopht.124.4.563

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

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