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Combined therapy for retinal angiomatous proliferation with intravitreal triamcinolone and argon laser photocoagulation
  1. R Mendis,
  2. T Leslie,
  3. V McBain,
  4. N Lois
  1. Department of Ophthalmology, Grampian University Hospitals–NHS Trust, Aberdeen, UK
  1. N Lois, Department of Ophthalmology, Grampian University Hospitals–NHS Trust, Foresterhill, Aberdeen AB25 2ZN, UK; noemilois{at}aol.com

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The occurrence of retinal neovascularisation at the macula in age-related macular degeneration (AMD) was described by Hartnett et al.1 Yannuzzi et al coined the term “retinal angiomatous proliferation” (RAP) to refer to this condition.2 RAP represents 10–12% of all neovascular AMD.3

A RAP should be suspected by the presence of a red nodular mass within the retina, representing intraretinal neovascularisation (IRN), associated with intraretinal haemorrhages and oedema, especially cystoid macular oedema, in a patient with AMD.2 Retinal arteries and veins often feed and drain, respectively, this lesion. Extension of the neovascularisation into the subretinal space (SRN) may occur, usually associated with neurosensory retinal detachment or retinal pigment epithelial (RPE) detachment (PED).2 In late stages, choroidal neovascularisation (CNV) may ensue.2

The natural history of RAP is poor; in most patients vision is reduced to ⩽20/200.4 Furthermore, poor visual outcomes have been usually achieved following treatment.3 57

A retrospective review of all consecutive patients with RAP treated with combined argon laser photocoagulation (ALP) and intravitreal triamcinolone (IVT) was undertaken. Twelve patients (13 eyes) with stage 1 and 2 extra- or juxtafoveal RAP were found. Vision improved (⩾2 Snellen lines) in five eyes (38%), deteriorated (⩾2 …

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