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Intravitreal triamcinolone and laser photocoagulation for retinal angiomatous proliferation
  1. T R Krieglstein,
  2. A Kampik,
  3. M Ulbig
  1. Department of Ophthalmology, Ludwig-Maximilians-University of Munich, Munich, Germany
  1. Correspondence to: T R Krieglstein Department of Ophthalmology, Ludwig-Maximilians-University of Munich, Mathildenstr. 8, 80336 Munich, Germany; Tina.Krieglstein{at}med.uni-muenchen.de

Abstract

Background: Recently, the entity of retinal angiomatous proliferation (RAP) as a subtype of exudative age-related macular degeneration was described, but no treatment options have been established as yet. The only two therapeutic modalities being discussed are surgical lysis of the feeding arteriole and draining venule, and the use of photodynamic therapy combined with intravitreal triamcinolone injection.

Aim: To examine focal laser treatment of early extrafoveal intraretinal neovascularisation of RAP.

Methods: Prospective case series. We included 13 consecutive patients with an extrafoveal RAP stage I lesion. All patients underwent a complete ophthalmic examination, including fluorescein angiography and optical coherence tomography (OCT) III before treatment and at 2 weeks, 1, 2 and 4 months afterwards. In cases with marked macular oedema (>350 μm retinal thickening in OCT III, r = 12), intravitreal injection of 4 mg triamcinolone was given before focal laser treatment to reduce the oedema.

Results: This case series indicates anatomical improvement or stabilisation in patients with an extrafoveal RAP lesion after treatment. Initial visual acuity ranged from 0.1 to 0.6 on the Snellen chart. By calculating logarithmic values, visual acuity was seen to be improved in five cases (2 to 5 log lines), deteriorated in four cases (−2 to 5 log lines) and stabilised in four cases (−1 to +1 log line change). Exudation on fluorescein angiography was stopped in 11 cases.

Conclusions: This preliminary case series suggests laser photocoagulation combined with prior intravitreal triamcinolone injection as a viable treatment option for RAP stage I. In cases with marked macular oedema, intravitreal triamcinolone injection improved visual acuity. For long-term stabilisation, additional laser treatment is mandatory. These preliminary results warrant a more detailed prospective clinical trial.

  • ARMD, age-related macular degeneration
  • BCVA, best-corrected visual acuity
  • CRA, chorioretinal atrophy
  • FVS, fibrovascular scar
  • IVTA, intravitreal triamcinolone
  • MAR, minimum angle of resolution
  • OCT, optical coherence tomography
  • PDT, photodynamic therapy
  • PED, pigment epithelium detachment
  • RAP, retinal angiomatous proliferation
  • RCA, retinal choroidal anastomosis

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Footnotes

  • Published Online First 2 August 2006

  • Competing interests: None declared.

  • Presented in part at the Société Francaise d̀ Ophthalmologie meeting, May 2005, Paris, France and the joint meeting of 103rd DOG Congress/15th SOE Congress, September 2005, Berlin, Germany.

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