Intravitreal triamcinolone prolongs the vascular remodelling of choroid after pholodynamic therapy.

Purpose: To verify if intravitreal triamcinolone (IVT) can modify the course of the vascular events on choroidal circulation which follow photodynamic therapy (PDT). Methods: Eighteen patients (18 eyes) with age–related macular degeneration (AMD) and minimally–classic choroidal newvessels (CNV) received 4 mg of IVT (Group IVT+PDT). After 3 weeks they were treated with PDT. Twenty patients (20 eyes) with AMD–CNV were treated with only PDT according to the standard protocol (Group PDT). Both groups were submitted to fluorescein and indocyanine green angiography before any procedure, 30 min, 1 day, 7 days and 1 month after PDT. Results: Fourteen patients in Group IVT+PDT (78%) and 18 in Group PDT (90%) showed increased permeability either 30 min or 1 day after PDT, of both CNV and normal choroidal vessels within the treatment spot. At 7 days all patients showed different degrees of closure of the CNV and choroidal vessels. At 1 month, 17 patients (94%) in Group IVT+PDT and only 2 (10%) in Group PDT showed angiographic signs of non perfusion of both CNV and normal choroid (P<0.05). Conclusions: Photodynamic therapy (PDT) determines a temporary closure of choroidal vessels and CNV which lasts for some weeks after treatment. Most recurrences are evident at 1 month. In this study IVT seems to prolong the collapsing effect of PDT, both in CNV and normal choroid within the treatment spot. IVT may conceavably block the suspected PDT–mediated pro–angiogenic effect which follows photothrombosis. A randomized trial is needed to verify the long–term efficacy of combining IVT and PDT in the treatment of minimally classic CNV.