The use of subretinal triamcinolone acetonide in the management of neovascular age-related macular degeneration : a pilot study

Abstract Background: We conducted this study to investigate the toxicity and efficacy of pars plana vitrectomy combined with a single dose of subretinally administered triamcinolone acetonide (4 mg) in patients with subfoveal choroidal neovascular membranes secondary to age-related macular degeneration (AMD). Methods: The important eligibility criteria included eyes with recent and progressive onset of decreased vision (≤ 20/400) secondary to active subfoveal choroidal neovascularization secondary to AMD demonstrable on fluorescein angiography, in which subretinal hemorrhage accounted for Results: Patient 1 sustained a limited subretinal hemorrhage intraoperatively that cleared spontaneously over approximately 3 months, as well as a rise in intraocular pressure that required the use of 2 topical medications to control. Patient 2 demonstrated progression of his nuclear sclerosis and posterior subcapsular lens changes over the 35 months of follow-up. Best-corrected visual acuity improved from 20/400 to 20/200 in patient I and improved from counting fingers to 20/320 in patient 2. For patient 1, the area of the neovascular complex increased from 4.5 mm 2 at baseline to 7.2 mm 2 at the 6-month follow-up; for patient 2, this increase was from 6.2 mm 2 to 8.4 mm 2 . Over the same interval, the greatest linear dimension increased from 3.8 mm to 4.8 mm for patient 1 and from 4.1 mm to 4.8 mm for patient 2. With respect to the multifocal ERG, the response density increased in the first 4 months for patient 1 and declined marginally thereafter. For patient 2, the electroretinal response density function was stabilized for a 5-month period but declined and stabilized thereafter. Interpretation: Our results from this pilot study suggest that vitrectomy combined with subretinal injections of 0.1 mL of triamcinolone ace-tonide (40 mg/mL) and air-fluid exchange is easily accomplished. Although some complications were encountered, these did not appear to be prohibitive. A salutary effect was clearly demonstrated, not unlike the course seen with photodynamic therapy. Further study, perhaps in combination with other antiangiogenic agents, is warranted.