Optical coherence tomography guided retreatment of photodynamic therapy

In vivo optical coherence tomography-guided photodynamic therapy for skin pre-cancer and cancer

BACKGROUND

The primary aim of this prospective study is to demonstrate the technical feasibility of OCT to map real tumor margins and to monitor skin changes that occurred post- PDT. Moreover, to optimize PDT efficacy based on the relationship between measured OCT features and treatment outcome.

MATERIAL AND METHODS

A series of 12 patients with overall 18 facial skin lesions were investigated by OCT before surface illumination by PDT to determine tumor free margins. Monitoring of the healing process was undertaken at 3, 6 and 12 months post-PDT. Parameters measured by the in vivo OCT during healing phase were the organization of skin layer and the degree skin fibroses for the active center and peripheral transit zone of the treated lesion. Clinical and aesthetics assessment was carried out at 12-month post-PDT.

RESULTS

Distinct microstructural differences between normal skin, pre-cancer, cancer, and the transition zone between the two tissues were observed on OCT images. In the subsequent healing phase, OCT demonstrate marked delineation and organization of skin layer at late stage of healing. Early features showing bizarre non-homogenous disorganized layering (scab) but afterwards, OCT was able to differentiate between different histological layers. One lesion demonstrated clinical healing by fibrosis (scar) without sign of recurrence. Another lesion demonstrated skin erythema. Only one lesion did not response to treatment despite margins clearance. The CR rate was 95% at the end of the study. The cosmetic effect was "excellent" in 89% of the patients.

CONCLUSIONS

This feasibility study lays the groundwork for using OCT as a real-time, noninvasive monitoring device for PDT in patients with skin cancer.

Response of Retinal Sensitivity to Intravitreal Anti-angiogenic Bevacizumab and Triamcinolone Acetonide for Patients with Diabetic Macular Edema over One Year

AIM

The aim of this study was to evaluate and compare microperimetry changes in patients with clinically significant diabetic macular edema secondary to diabetes mellitus, following intravitreal injections of bevacizumab or triamcinolone during a follow-up of 1 year after treatment.

MATERIALS AND METHODS

30 patients with clinically significant macular edema were randomized into two groups of 15 patients each. One group initially received three intravitreal injections of 2.5 mg bevacizumab at monthly intervals. The other received a single injection of 8 mg of triamcinolone followed by two sham interventions at monthly intervals. Best-corrected visual acuity (BCVA) and central retinal thickness (CRT) were measured. Macular function was documented by microperimetry at baseline, 3, 6, 9 months and at the last visit of each patient.

RESULTS

In the bevacizumab group, the mean differential light threshold (±standard deviation) under therapy improved significantly from 8.40 (± 3.8) dB to 12.8 (±4.3) dB at the 12-month follow-up visit (p ≤ .05), whereas in the triamcinolone group it increased from 8.0 (± 2.4) dB at baseline to 9.3 (±3.6) dB at the last visit without reaching statistical significance (p > .05). The mean differential light thresholds between the two groups were not statistically significant at baseline or the last visit (p > .05). In the bevacizumab group, the improvement (slope) in mean differential light threshold was significantly superior to the Triamcinolone group (Estimate = 0.588, p ≤ .05).

CONCLUSION

Central macular function as measured by microperimetry in patients with acute DME improved in addition to anatomical restoration after intravitreal bevacizumab and triamcinolone injection. In our clinical study, the measures of the variables in patients receiving bevacizumab were superior to those receiving triamcinolone throughout the one-year observation period.

Photodynamic therapy monitoring with optical coherence angiography

Photodynamic therapy (PDT) is a promising modern approach for cancer therapy with low normal tissue toxicity. This study was focused on a vascular-targeting Chlorine E6 mediated PDT. A new angiographic imaging approach known as M-mode-like optical coherence angiography (MML-OCA) was able to sensitively detect PDT-induced microvascular alterations in the mouse ear tumour model CT26. Histological analysis showed that the main mechanisms of vascular PDT was thrombosis of blood vessels and hemorrhage, which agrees with angiographic imaging by MML-OCA. Relationship between MML-OCA-detected early microvascular damage post PDT (within 24 hours) and tumour regression/regrowth was confirmed by histology. The advantages of MML-OCA such as direct image acquisition, fast processing, robust and affordable system opto-electronics, and label-free high contrast 3D visualization of the microvasculature suggest attractive possibilities of this method in practical clinical monitoring of cancer therapies with microvascular involvement.

Intraretinal cysts are the most relevant prognostic biomarker in neovascular age-related macular degeneration independent of the therapeutic strategy

BACKGROUND/AIMS

To investigate the impact of antiangiogenic monotherapy and photodynamic therapy (PDT) as add-on strategy on retinal morphology, and to analyse prognostic biomarkers for visual outcome and retreatment frequency in neovascular age-related macular degeneration (nAMD).

METHODS

255 patients participating in the MONT BLANC study were evaluated. Patients were randomised to receive as-needed ranibizumab monotherapy or combination therapy (verteporfin PDT and ranibizumab). Outcome measures included visual acuity (VA), retinal morphology assessed by optical coherence tomography and retreatment frequency.

RESULTS

The proportion of scans showing intraretinal cysts (IRC) or subretinal fluid (SRF) decreased more intensively in the combination than in the monotherapy group. Pigment epithelial detachments (PED) decreased significantly only in the combination group. Patients with IRC presented the lowest initial VA, and IRC had the strongest negative predictive value for functional improvement in both groups. SRF showed a predictive value for a higher number of ranibizumab injections (combination, +0.9; monotherapy, +0.8) and a higher number of PDT treatments in the combination group (+0.3). PED was associated with a higher number of ranibizumab injections only in the monotherapy group (+1.2).

CONCLUSIONS

Combination and monotherapy showed a distinct response pattern for morphological parameters in nAMD. IRC was the only relevant prognostic parameter for functional outcome.

TRIAL REGISTRATION NUMBER

NCT00433017.

In-vivo investigation of laser-induced choroidal neovascularization in rat using spectral-domain optical coherence tomography (SD-OCT)

PURPOSE

This study investigated the in-vivo formation process of laser-induced choroidal neovascularization (CNV) in rat using high-resolution spectral-domain optical coherence tomography (SD-OCT), and compared the results to histological methods.

METHODS

Brown Norway rats (n = 60, 6-8 weeks of age) received 532-nm diode laser photocoagulation. SD-OCT and fluorescein angiography (FA) were performed in vivo 2, 5, 7, 14, and 21 days post-laser application. Haematoxylin and eosin (H&E) staining and immunohistochemistry for CD31, phosphorylated vascular endothelial factor receptor 2 (pVEGFR2) were conducted at each time point to observe the CNV in vitro. Choroidal flatmount preparations were observed using a confocal laser scanning microscope (CLSM) and a scanning electron microscope (SEM).

RESULTS

SD-OCT monitored the longitudinal morphological changes of laser-induced CNV. CNV reached its maximal size on day 7, and began a gradual reduction on day 14. FA revealed similar dynamic changes in leakage. CNV thickness, as assessed by SD-OCT, was consistent with H&E-stained sections at each time point. CLSM and SEM revealed the details of the fibrovascular membrane. CD31 and pVEGFR2 expression supported the results of SD-OCT and histology.

CONCLUSIONS

SD-OCT was a convenient and reliable tool for the imaging of the CNV formation process and quantification of the lesion size in vivo.

Errors in thickness comparison maps from 3D optical coherence tomography

BACKGROUND AND OBJECTIVE

To study characteristics of errors in thickness comparison maps (TCMs) from three-dimensional optical coherence tomography.

PATIENTS AND METHODS

Patients who underwent three-dimensional optical coherence tomography examinations were included. Errors in TCM were categorized into several types according to common features, and the origins and distributions of errors were investigated.

RESULTS

Errors were observed in 25 (22.9%) of 109 TCMs with a normal macula and in 88 (63.3%) of 139 TCMs with an abnormal macula (P < .001). The errors were categorized into three types: horizontal line-shaped errors that originated from fixation loss by the examinee, jumping errors caused by segmentation error, and two-peaked errors due to mismatching. There were significant differences in the distributions of the error types among different diagnoses.

CONCLUSION

Errors in TCM were categorized into several types according to common features. Distributions of these types differed among eyes according to diagnosis.

Imaging in neovascular age-related macular degeneration

Imaging plays an essential role in the diagnosis and treatment of age-related macular degeneration (AMD). This review describes the imaging modalities most commonly employed by ophthalmologists caring for patients with neovascular AMD. Imaging modalities discussed include fluorescein angiography, optical coherence tomography, indocyanine green angiography, and fundus autofluorescence.

Early visual impacts of optical coherence tomographic parameters in patients with age-related macular degeneration following the first versus repeated ranibizumab injection

BACKGROUND

The aim of this study is to evaluate the early visual impacts of various optical coherence tomographic (OCT) parameters after the first versus repeated intravitreal ranibizumab injection in patients with exudative age-related macular degeneration (AMD).

METHODS

A retrospective comparative case series study was conducted on 20 eyes of 18 consecutive patients who received intravitreal ranibizumab injection for exudative AMD either for the first time (group 1; n = 8) with no prior anti-vascular endothelial growth factor (anti-VEGF) injection in the same or fellow eye, or for repeated times during the course of monthly injected ranibizumab (group 2; n = 12 eyes). The following baseline and 1 month post-injection data was collected for both groups and compared: best-corrected visual acuity (BCVA), qualitative and quantitative OCT parameters including: foveal thickness, foveal volume (central 1-mm circle), retinal volume at 3- and 5-mm central circles, retinal pigment epithelium (RPE) elevation, type of fluid collections, and type of AMD lesion. The size of the fluid and fibrovascular lesion (FVL) areas were measured using manual delineation and automatic calculation of the device. We made correlations between the post-injection visual acuity (VA) and each of post-injection OCT parameters in both groups and these were the main outcome measures.

RESULTS

In group 1, there was a strong correlation between post-injection logarithm of minimum angle of resolution (logMAR) BCVA and each of the following: FVL size, foveal thickness, retinal volume at 3- and 5-mm central circles, RPE elevation, the size of the fluid area, and age of the patient (r > 0.70, p < 0.05), whereas in group 2; logMAR BCVA was strongly correlated only with foveal volume (r = 0.74, p = 0.01). Multivariate analysis showed that post-injection FVL size (r (2) = 0.69) and foveal volume (r (2) = 0.55) were the most important factors for VA 1 month following the initial and repeated ranibizumab injection, respectively.

CONCLUSIONS

The size of FVL and foveal volume showed a significant correlation with VA in AMD patients shortly after the first and repeated ranibizumab injection, respectively. Further studies with larger sample sizes are needed in order to support these results.

Evaluation of artifacts associated with macular spectral-domain optical coherence tomography

PURPOSE

To characterize the types and frequencies of image artifacts associated with macular scanning using 2 common spectral-domain optical coherence tomography (SD OCT) instruments and to evaluate the impact of artifacts on foveal thickness measurements.

DESIGN

Retrospective, observational chart review.

PARTICIPANTS

For the Cirrus HD-OCT (Carl Zeiss Meditec, Dublin, CA), scans of 98 eyes from 58 patients were included in the study. For the Spectralis HRA+OCT (Heidelberg Engineering, Heidelberg, Germany), scans of 88 eyes from 54 patients were included.

METHODS

Macular volume scans of healthy and diseased eyes were evaluated systematically for image artifacts within each scan overall and within the center 1-mm area. The frequency of each artifact type was compared for scans stratified by diagnosis category. Artifacts in the center 1-mm area were graded for severity and were corrected manually using each instrument's software. Artifacts that resulted in errors of more than 50 microm or more than 10% of retinal thickness or that caused a misdiagnosis of macular edema or retinal thinning were defined as clinically significant and were analyzed further.

MAIN OUTCOME MEASURES

Overall frequency of image artifacts by artifact type, relative frequency of artifacts in scans stratified by posterior segment disease diagnosis, and retinal thickness measurements of the center 1-mm subfield before and after artifact corrections.

RESULTS

For Cirrus, 84.7% of scans had artifacts and 32.7% had at least 1 artifact in the center 1-mm area of the scan. For Spectralis, 90.9% of scans had at least 1 artifact, and 37.5% had at least 1 artifact in the center 1-mm area. Certain artifact types were observed more frequently with specific disease states. Clinically significant artifacts involving the center 1-mm area were seen in 5.1% of Cirrus and 8.0% of Spectralis scans.

CONCLUSIONS

Image artifacts in SD OCT volume scanning are common and frequently involve segmentation errors. Artifacts are relatively less common in the center 1-mm area of scans, but may affect retinal thickness measurements in a clinically significant manner. Careful review of scans for artifacts is important when using SD OCT images and retinal thickness measurements in patient care or clinical trials.

Relationships between clinical measures of visual function and anatomic changes associated with bevacizumab treatment for choroidal neovascularization in age-related macular degeneration

PURPOSE

This pilot study was undertaken to examine the relationships between clinical measures of visual function and anatomic changes occurring in the eyes treated with bevacizumab for choroidal neovascularization (CNV) due to age-related macular degeneration (AMD).

METHODS

A retrospective review was conducted for 50 eyes that had been treated with at least three injections of bevicizumab for CNV due to AMD, and followed for at least 6 months. Vision outcomes included best-corrected ETDRS chart acuity, scored by best-line read (ETDRS line) and by total letters read (ETDRS letter), and two measures obtained from central acuity perimetry with 98% Michelson contrast targets, the best acuity within 6 degrees of fixation (BA6 degrees ), and global macular acuity (GMA), representing a weighted average of the acuities thresholded at all intercepts within a 10 degrees radius of fixation. Assessment of anatomic outcomes included fibrosis, atrophy, and subretinal hemorrhage grading on fundus photography, CNV size, pigment epithelial detachment (PED) size and grading of CNV leakage on fluorescein angiography, and central retinal PED, and subretinal fluid (SRF) thickness on optical coherence tomography.

RESULTS

Logistic regression analysis showed an association between the vision outcomes of EDTRS letter and BA6 degrees with the change in SRF thickness (R (2): 0.47 and 0.35, respectively). The outcome of the vision measurement of GMA was associated with the change in SRF thickness, in CNV thickness, and in CNV fibrosis grade (R (2): 0.34). No association was noted between the outcomes of ETDRS line with the change in any anatomic outcomes.

CONCLUSION

Acuity perimetry outcomes in this study seemed to offer improved understanding of the relationship between the vision outcomes and the measured anatomic changes. It seemed that neither ocular coherence tomography nor fluorescein angiography alone offered sufficient morphologic markers for prediction of functional outcomes.

Relationship between optical coherence tomography retinal parameters and visual acuity in neovascular age-related macular degeneration

PURPOSE

To investigate the relationship between optical coherence tomography (OCT)-derived measurements of retinal morphology and visual acuity in patients with neovascular age-related macular degeneration (AMD).

DESIGN

Retrospective cross-sectional study.

PARTICIPANTS

A total of 216 consecutive patients (216 eyes) newly diagnosed with neovascular AMD who underwent StratusOCT imaging at the time of diagnosis.

METHODS

Best-corrected Snellen visual acuity was recorded for each patient. Raw exported StratusOCT images for each patient were analyzed using publicly available custom software entitled "OCTOR," which allows the precise positioning of prespecified boundaries on individual B-scans. Thickness and volume were calculated for morphologic parameters of interest: neurosensory retina, subretinal fluid, subretinal tissue (SRT), and pigment epithelial detachment.

MAIN OUTCOME MEASURES

OCT-derived measurements of retinal morphology and visual acuity.

RESULTS

An increased total volume of SRT was correlated with decreased visual acuity (r = 0.370, P<0.0001). Decreased visual acuity was also modestly correlated with increased thickness of the neurosensory retina at the foveal center point (r = 0.245, P = 0.0004). No statistically significant association was detected between visual acuity and the total volume of subretinal fluid or pigment epithelial detachment. The association between visual acuity and both the neurosensory retina and the SRT was stronger for lesions classified as minimally classic or occult on fluorescein angiography. For occult lesions, 20% of the variation in visual acuity could be predicted by a multiple regression model that incorporated age and SRT volume, whereas, for minimally classic lesions, 62% of the variation in visual acuity could be predicted by a multiple regression model that incorporated age, total neurosensory retinal volume, and total SRT volume.

CONCLUSIONS

The presence of increased SRT thickness and volume on OCT, and to a lesser extent increased neurosensory retinal thickness and volume, is associated with decreased visual acuity in neovascular AMD. However, because of the complex pathophysiology of neovascular AMD and, in part, the limitations of StratusOCT, these factors only account for a small degree of the variation in visual acuity that these patients exhibit. The detection of stronger correlations between retinal anatomy and visual acuity is likely to require the use of more advanced imaging modalities.

FINANCIAL DISCLOSURE(S)

Proprietary or commercial disclosure may be found after the references.

Optical coherence tomography findings during pegaptanib therapy for neovascular age-related macular degeneration

BACKGROUND

To evaluate macular thickness measured by optical coherence tomography (OCT) during pegaptanib therapy for neovascular age-related macular degeneration (AMD).

METHODS

For this prospective, nonrandomized, observational case series, 41 eyes from 41 patients with neovascular AMD received intravitreous pegaptanib (1 mg) injections repeated every 6 weeks. The primary outcome measure was central foveal thickness measured by OCT. Secondary outcomes were fluorescein angiographic leakage and visual acuity.

RESULTS

Mean thickness of the central area on OCT decreased from 340 +/- 24 microm to 299 +/- 14 microm after 12 weeks of pegaptanib injections. This represents a reduction in thickening of 32%. Fluorescein angiograms with definite leakage decreased from 100% to 81%, and mean visual acuity decreased from 20/116 to 20/120.

CONCLUSIONS

Intravitreal injections of pegaptanib at 6-week intervals result in a moderate reduction of central foveal thickness in eyes with subfoveal neovascular AMD. This presents a modest effect relative to that reported with other anti-angiogenic agents.

Optical coherence tomography analysis of a randomized study combining photodynamic therapy with intravitreal triamcinolone

BACKGROUND

The objective of the study was to analyze optical coherence tomography (OCT) scan differences between patients with predominantly classic subfoveal choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD) treated with only photodynamic therapy (PDT) and patients treated with PDT combined with intravitreal triamcinolone acetonide (IVTA).

METHODS

In this prospective study, 61 patients were randomized to receive PDT (n = 30) or PDT combined with IVTA (n = 31). They were evaluated every 3 months with a refraction protocol for best-corrected visual acuity (VA) measured with Early Treatment Diabetic Retinopathy Study (ETDRS) charts, fluorescein angiography (FA), and OCT. When measuring foveal thickness on OCT scans, neuroretinal foveal thickness (NFT) was differentiated from outer high reflectivity band thickness (OHRBT). The main outcome measures were mean change in OCT measurements and correlation of VA and angiographic area of the lesion with OCT measurements.

RESULTS

At the 12-month follow-up, the mean change in NFT was not significantly reduced (P = 0.9), but the mean change in OHRBT was significantly lower (P = 0.004) in the group of patients who received combined therapy. There was no correlation between final VA and NFT in either patient group (P = 0.2). The final VA was significantly worse in eyes with a thicker OHRBT (P = 0.04) in the group of patients treated with only PDT. There was no correlation between angiographic area and NFT and OHRBT in either patient group (P > 0.3). There was a statistically significant difference between the pre-treatment angiographic area of the lesion and VA at the 12-month follow-up in the combined therapy group (P = 0.01), and more eyes treated with only PDT presented with intraretinal fluid at the last follow-up (P = 0.01).

CONCLUSION

Combined PDT+IVTA therapy was more effective than PDT alone at reducing OHRBT. This OCT measurement seems to be have a greater effect on VA than NFT.

Measurement of greatest linear diameter for choroidal neovascular membrane using optical coherence tomography

PURPOSE

Correlation of greatest linear diameter (GLD) of choroidal neovascularization (CNV) measured by fundus fluorescein angiography (FA) with optical coherence tomography (OCT).

DESIGN

Retrospective noninterventional observational case series.

METHODS

Patients who underwent verteporfin therapy for subfoveal classic CNV were assessed. GLD of CNV was calculated manually from mean of 6 line scans. GLD measured on OCT and FA was correlated by assessing the agreement of the two techniques by interclass correlation and Bland and Altman technique.

RESULTS

Twenty-seven eyes of 27 patients with subfoveal classic CNV were included. The mean age was 49.3 +/- 18.6 years. The mean GLD calculated on FA was 1973.3 microm and OCT was 2024.2 microm. Substantial agreement was observed between GLD measured on FA and OCT (Inter-Class Correlation [ICC] = 0.77%; 95% confidence interval, 0.56 to 0.89).

CONCLUSIONS

GLD measured on OCT correlates to FA measurement. This method could be beneficial where FA is contraindicated while contemplating photodynamic therapy (PDT).

Fluorescein Angiography Compared to Three-Dimensional Measurements by the Retinal Thickness Analyzer in Classic Choroidal Neovascularization

PURPOSE

To compare and correlate imaging of classic subfoveal choroidal neovascularization (CNV) with noninvasive 3-dimensional imaging by the retinal thickness analyzer (RTA) to conventional fluorescein angiography (FA).

METHODS

A total of 29 eyes of 29 consecutive patients with predominantly classic CNV eligible for photodynamic therapy underwent FA and RTA imaging. The FA dimensions of the CNV were measured independently by two graders. With the RTA, masked to FA the size of the CNV itself as imaged in 3-dimensional reconstruction, the size of significantly thickened retina overlying the CNV and the maximum retinal thickness were measured.

RESULTS

The mean diameter of the CNV determined from 3-dimensional RTA reconstructions showed an excellent correlation with measurements from FA (r = 0.91, p < 0.001). The area of retinal thickening was by a mean of 0.7 mm in diameter larger and correlated moderately well with the size of the CNV on FA (r = 0.65, p < 0.001). In contrast, there was no correlation between the absolute retinal thickness and the CNV size on FA.

CONCLUSIONS

Noninvasive quantitative mapping of predominantly classic CNV by RTA is feasible and also allows 3-dimensional measurement of the lesion itself. The results correlate well with FA assessment but visualize different properties of the disease.

Alignment artifacts in optical coherence tomography analyzed images

PURPOSE

To compare retinal thickness and retinal height of the original scanned optical coherence tomography (OCT) images with those of the same images after automated retinal thickness analysis.

DESIGN

Cross-sectional study.

PARTICIPANTS

Thirty normal eyes, 20 eyes with neovascular age-related macular degeneration (AMD), 20 with central serous chorioretinopathy (CSC), 20 with macular holes, and 20 with non-AMD related macular edema from 110 subjects were selected randomly from an OCT database. One of the 6 macular scans in each eye was chosen randomly for analysis.

METHODS

Two sets of OCT images--original images and analyzed images (after retinal thickness [single eye] analysis)--in each eye were exported for retinal thickness or retinal height measurement. Comparisons of retinal thickness or retinal height at selected locations were performed.

MAIN OUTCOME MEASURES

Retinal thickness (defined as the distance between the anterior boundary of the retinal nerve fiber layer [RNFL] and posterior boundary of the photoreceptor layer) and retinal height (defined as the distance between the anterior boundary of the RNFL and baseline level of the anterior boundary of the retinal pigment epithelium [RPE]). Retinal height was measured when there was detachment of neurosensory retina or RPE.

RESULTS

No significant difference in retinal thickness was observed between the original and the analyzed OCT images in normal eyes and in eyes with macular holes or non-AMD related macular edema. However, OCT-analyzed images demonstrated retinal thickness or retinal height measurements in eyes with CSC or neovascular AMD significantly lower than the corresponding measurements in the original images (all with Ps< or =0.001, Wilcoxon signed rank test). In the groups of neovascular AMD and CSC, Bland-Altman plots revealed mean differences of 124 mum (95% limits of agreement between -65.5 and 313.6) and 84.4 mum (95% limits of agreement between -178.0 and 346.8), respectively, between the original and analyzed retinal measurements.

CONCLUSIONS

Retinal thickness and retinal height could be underestimated in patients with CSC or neovascular AMD after retinal thickness analysis in Stratus OCT when either automatic measurements or manual caliper-assisted measurements are performed on the analyzed images. We recommend exporting the original scanned OCT images for retinal thickness and retinal height measurement in patients with CSC or neovascular AMD.

Prognosis of untreated occult choroidal neovascularization

PURPOSE

The aim of this investigation was to evaluate prognostic factors influencing the short-term prognosis of occult choroidal neovascularization (CNV).

METHODS

A consecutive series of 107 untreated occult CNV in 101 patients were evaluated in terms of the effect of their initial lesion characteristics, as determined with fluorescein angiography (FA), indocyanine green angiography (ICG-A) and optical coherence tomography (OCT), on the change in distance acuity, lesion size and retinal thickness over 1-3 months. Descriptive statistics, the Pearson Correlation Coefficient and a multiple linear regression analysis were applied to treat the data.

RESULTS

A total of 107 eyes (101 patients) were examined. The study cohort consisted of 35 males and 66 females, with a mean age of 77.6 years. During the 3-month study period the mean distance acuity decreased from 67.0 to 63.2 letters; the mean size of the lesion increased from 16.1 to 18.4 mm(2); the mean maximum retinal thickness increased from 374.5 to 387.5 mum. Of the lesions, 59.8% included pigment epithelial detachments (serous or fibrovascular) and 29.9% retinal angiomatous proliferation. A better distance acuity at both visits for the entire study population correlated significantly with smaller lesions, as determined by FA and ICG-A (p < 0.0001), and a lower maximum retinal thickness, as determined by the OCT (p < 0.0001).

CONCLUSIONS

A small and statistically insignificant change in distance acuity, lesion size and retinal thickness occurred over the 3 months of the study period. This reduced the ability of the study to examine the effect of baseline findings on outcome. Only two factors - the presence of a RAP lesion or the presence of CNV in the other eye - significantly and adversely affected the distance visual acuity at follow-up.

A new treatment regimen in combined intravitreal injection of triamcinolone acetonide and photodynamic therapy

BACKGROUND

Combined photodynamic therapy (PDT) and intravitreal injection of triamcinolone acetonide is a new option in the treatment of the neovascular form of age-related macular degeneration. With the aim of increasing safety and efficacy we examined whether it is possible to administer the intravitreal injection prior to PDT.

METHODS

Patients with retinal angiomatous proliferation, who have an unfavourable prognosis when treated with PDT alone, were recruited to this study. Intravitreal injection of triamcinolone acetonide was applied 1 day before PDT. Distance acuity testing, retinal thickness measurement and fluorescein angiography were performed before treatment and 6 weeks and 3 months thereafter.

RESULTS

Twenty-five patients were included: 18 were female, 7 male. Their mean age was 79 years. The distance acuity was 68 letters before treatment and at the follow-up examinations. The retinal thickness decreased significantly from mean 470.8 microm to 335.4 microm at week 6 and 360.8 microm at month 3. At month 3, 48% showed signs of activity in the fluorescein angiography needing retreatment. Visualisation of the fundus was not reduced by the triamcinolone crystals.

DISCUSSION

PDT was possible without difficulty after intravitreal injection of triamcinolone acetonide. Stabilisation of the visual acuity was possible, although only eyes with retinal angiomatous proliferation were included.