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Outcomes after combination photodynamic therapy and immunosuppression for inflammatory subfoveal choroidal neovascularisation

¹ Research Foundation, Royal Victoria Eye and Ear Hospital, Adelaide Road, Dublin 2, Ireland
² Department of Ophthalmology, Royal Victoria Eye and Ear Hospital, Adelaide Road, Dublin 2, Ireland
³ Department of Ophthalmology, Royal College of Surgeons in Ireland, Royal Victoria Eye and Ear Hospital, Adelaide Road, Dublin 2, Ireland

Correspondence to:
Correspondence to:
Mr Dara J Kilmartin
MSc, FRCSI, FRCOphth, Department of Ophthalmology, Royal College of Surgeons in Ireland, Royal Victoria Eye and Ear Hospital, Adelaide Road, Dublin 2, Ireland; djkilmartin{at}eircom.net

ABSTRACT
Aim: To report the visual and angiographic outcomes after combination photodynamic therapy (PDT) and immunosuppression for inflammatory subfoveal choroidal neovascularisation (CNV).

Methods: Retrospective review of six consecutive patients, five female and one male, aged 23–40 years with active subfoveal CNV secondary to posterior uveitis. Patients received either intravitreal triamcinolone or systemic immunosuppression (mycophenolate mofetil, tacrolimus) and PDT. Five patients had intravitreal triamcinolone injections and two patients were on systemic immunosuppression; all patients underwent PDT (mean two treatments). Visual acuity was measured on a 2 metre ETDRS chart and fluorescein angiograms were performed at each visit.

Results: Median follow up was 15 months (range 10–31). Vision improved by a median of 13 letters in five patients and remained stable (±1 letter) in one patient. Median visual acuity improved from 20/160 at presentation to 20/40 at latest follow up (p = 0.03). There was a reduction in clinical exudation and cessation of angiographic leakage in all six patients. All interventions were well tolerated.

Conclusion: Combination PDT and immunosuppression may be a useful therapeutic option for young patients with active inflammatory subfoveal CNV.

Abbreviations: CNV, choroidal neovascularisation; IL, interleukin; IVT, intravitreal triamcinolone; PDT, photodynamic therapy; PIC, punctate inner choroidopathy; POHS, presumed ocular histoplasmosis syndrome; TNF, tumour necrosis factor; VOH study, Verteporfin in Ocular Histoplasmosis study

Keywords: photodynamic therapy; immunosuppression; inflammatory choroidal neovascularisation

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