Intravitreal triamcinolone and laser photocoagulation for retinal angiomatous proliferation

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 \textgreekmm 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.