Verteporfin therapy in combination with triamcinolone: published studies investigating a potential synergistic effect

Evidence from randomized, placebo-controlled, double-masked studies has demonstrated that verteporfin (Visudyne) therapy is effective in reducing the risk of visual acuity loss in selected groups of patients with choroidal neovascularization (CNV) due to age-related macular degeneration (AMD). Pilot studies of intravitreal triamcinolone acetonide monotherapy revealed promising results in patients with CNV due to AMD, but the visual acuity outcomes in a randomized, controlled study were lower than anticipated. Recently, however, there has been growing interest in the adjunctive use of triamcinolone to improve visual acuity and reduce regrowth of CNV in patients receiving verteporfin therapy. This review article surveys the currently available evidence, based on a Medline search covering the years 1980-2005 and abstracts from recent scientific meetings. A number of small-scale, uncontrolled pilot studies have indicated that the combination of triamcinolone acetonide with verteporfin therapy may be beneficial. Evidence is now needed from randomized, controlled studies to determine whether the potential benefits of combination therapy outweigh the possible risks of increased intraocular pressure, endophthalmitis, and progression of cataract that have been observed in trials of triamcinolone monotherapy.