[Triple therapy for the treatment of choroidal neovascularization with pigment epithelium detachment in age-related macular degeneration].

Purpose: To investigate the effect of a triple therapy associating subtenon triamcinolone acetonide, intravitreous ranibizumab and photodynamic therapy for treatment of retinal pigment epithelium detachment (RPED) complicating occult choroidal neovascularization in age-related macular degeneration. PATIENTS-METHOD: A prospective clinical trial including 27 patients showing retinal pigment epithelium detachment. We treated these patients with intravitreous ranibizumab injections and subtenon triamcinolone injections as well as a single session of photodynamic therapy at 48 h. At least two more intravitreous ranibizumab injections were added at 1-month intervals.
Results: Initial visual acuity was 1.3/10 at 9 months, which was minimal follow-up. Twenty-three patients had total resumption of retinal pigment epithelium detachment on optical coherence tomography imaging after 1 month. One patient had ocular hypertension and needed trabeculectomy, one had a pigment epithelium break but with good functional results. Seven patients needed six intravitreous injections of ranibizumab with partial or total resumption in six cases.
Discussion: RPED is a severe complication of choroidal neovascularization in age-related macular degeneration. Untreated, it means a rapid loss of macular function. Often damage is bilateral. Simple intravitreous injection of ranibizumab is not satisfying. An association of photodynamic therapy and intravitreous triamcinolone injections shows good results. We propose a triple treatment for the best possible synergy. Our preliminary results are encouraging. Since we did not want to inject a large volume of Triamcinolone into the vitreous, we chose subtenon injections.
Conclusion: Treatment of retinal pigment epithelium detachment is difficult. Associating intravitreous injection of ranibizumab, dynamic phototherapy, and subtenon triamcinolone provides good results.
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