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

Figures & data

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.

Table 1 Clinical details of patients treated by PDT and IVTA for choroidal neovascularization associated with angioid streaks

Case	Age (year)/gender	CNV type location	Systemic Disease	No of PDT before IVTA†	Time interval (weeks) between IVTA and PDT	No of PDT + IVTA	CVA (LogMAR)
							Baseline	1-week later, and lines changed	BCVA at 1 mo	BCVA at 3 mo	BCVA at 6 and 12 mo	Change in BCVA at 12 mo from baseline (ETDRS lines)
1	40/F	Classic Subfoveal	PXE	3	1	2	0.3	0.7	0.7	0.7	0.7 1.0	−7
2	42/M	Classic Juxtafoveal	PXE	0	1	2	0.2	0.2	0.3	0.4	0.4 0.5	−3
3	48/F	Classic Juxtafoveal	PXE	4	1	1	0.1	0.2	0.2	0.2	0.3 0.3	−2
4	62/F	Classic Subfoveal	PXE	0	1	1	1.0	1.0	1.0	1.0	1.0 1.0	0
5	35/M	Classic Subfoveal	PXE	0	1	1	1.3	1.3	0.9	0.6	0.4 0.4	+9

Notes:

† N° of PDT (photodynamic therapy) given before IVTA (intravitreal triamcinolone acetate).

‡ Number of subsequent PDT courses administered after IVTA.

Abbreviations: M, male; F, female; BCVA, best-corrected visual acuity; CNV, choroidal neovascularization; PXE, pseudoxanthoma elasticum.