AIM:To report the appearance of choriocapillaris atrophy after combined high dose intravitreal triamcinolone acetonide (TA) and photodynamic therapy (PDT) to treat choroidal neovascularization (CNV) associated with age related macular degeneration (AMD).METHODS:The present study was retrospective about non-randomized interventional case series.Fifty-one consecutive eyes with subfoveal (all types) CNV associated with AMD were treated by PDT and intravitreal (19.4±2.1)mg per 0.1mL TA at the Alicante Institute of Ophthalmology.The appearance of macular choriocapillaris and retinal pigment epithelium (RPE) atrophy was considered at two years follow-up.Thirty consecutive eyes treated by PDT alone,matched for age,sex,and type and size of CNV were considered as control group.RESULTS:Twenty-one of 47 eyes in the study group (45%) and 7 of 30 eyes in the control group (23%) developed macular RPE and choriocapillaris atrophy in the treated area at month 24 (P =0.04,Chi-square test).The greatest diameter of the atrophic areas averaged (5044±1666)μm in the study group vs (4345±1550)μm in the control group.Mean final best corrected visual acuity (logarithm of minimal angle of resolution) was (0.87±0.33) in the cases with RPE atrophy vs (0.66±0.26) in the cases with no RPE atrophy in the study group (P=0.11,Mann-Whitney U test).CONCLUSION:The association of high doses of intravitreal TA and PDT may increase the risk for RPE and choriocapillaris atrophy.