Acute visual loss and chorioretinal infarction after photodynamic therapy combined with intravitreal triamcinolone G. LO GIUDICE 1 , V. DE BELVIS 2 , S. PIERMAROCCHI 2 , A. GALAN 1 , G. PROSDOCIMO 3 1 Department of Ophthalmology, Sant’Antonio Hospital, Padova 2 Department of Ophthalmology, University of Padova, Padova 3 Department of Ophthalmology, Conegliano Hospital, Treviso - Italy INTRODUCTION Although photodynamic therapy (PDT) improves the prog- nosis of exudative age-related macular degeneration (AMD), its effectiveness differs among different subtypes of choroidal neovascularization (CNV) (1). In particular, in cases where a serous detachment of the retinal pigment epithelium is associated with CNV, anatomic and func- tional results are not favorable after PDT (1). Recently, the combination of PDT with intravitreal triamcinolone (IVTA) European Journal of Ophthalmology / Vol. 18 no. 4, 2008 / pp. 652-655 1120-6721/652-04$25.00/0 © Wichtig Editore, 2008 PURPOSE. To report acute visual loss associated with dynamic vascular changes after photodynam- ic therapy (PDT) combined with intravitreal triamcinolone (IVTA) for the treatment of occult choroidal neovascularization (CNV). METHODS. An 86-year-old woman complained of visual loss in her left eye. Angiographic examina- tion showed a serous pigment epithelium detachment complicated by CNV. She underwent com- bined treatment with IVTA (4 mg) followed by standard verteporfin PDT administered after a 5-day interval. RESULTS. The patient developed vision loss 1 day after PDT. Ophthalmoscopic examination disclosed an acute serous neurosensory retinal detachment. Fluorescein angiography showed a large area of early hypofluorescence in correspondence to and extending beyond the photodynamic spot. Neu- rosensory retinal vessels involvement with dilation of the retinal arterioles and capillary nonperfu- sion were also revealed. Indocyanine green angiography showed choroidal infarction within the col- lateral choroid included in the area of light exposure, with associated nonperfusion of medium and large choroidal vessels being revealed. Five days after PDT, spontaneous severe bleeding with break- through into the vitreous occurred, in addition to an RPE tear. CONCLUSIONS. Acute loss of vision associated with vascular changes in retinal and choroidal circu- lation represents an uncommon but serious complication following combined PDT and IVTA. These risks should be carefully considered in combination therapies. (Eur J Ophthalmol 2008; 18: 652-5) KEY WORDS. Age-related macular degeneration, Choroidal neovascularization, Photodynamic therapy, Triamcinolone Accepted: January 16, 2008 SHORT COMMUNICATIONS & CASE REPORTS has been successfully used for the treatment of all types of CNV (2, 3). Several investigations in which verteporfin PDT was combined with IVTA indicate that therapy is more effective in improving visual outcomes, also reduc- ing the rate of retreatment compared to PDT alone. How- ever, despite the potential beneficial effects of combined treatment, the real impact on the retinal pigment epitheli- um (RPE), neural structures, and choroidal and retinal cir- culation remains unclear. We report a case of ocular complications following PDT