Combined surgical ablation and intravitreal triamcinolone acetonide for retinal angiomatous proliferation.
OBJECTIVE
Neovascular age-related macular degeneration (ARMD) with retinal angiomatous proliferation (RAP) has a poor natural history and the efficacy of any treatment has not yet been established. The authors describe a combined surgical treatment.


METHODS
A 76-year-old woman presented with a best-corrected visual acuity (BCVA) of 20/600 in the right eye and macula with stage 3 RAP as identified by fluorescein angiography (FA), indocyanine green angiography (ICGA), and optical coherence tomography (OCT). After a standard three-port pars plana core vitrectomy (PPV), endodiathermy of the arteriolar and venous feeder vessels of each lesion was performed, intraretinal RAP feeder vessels were cut with manual vertical intraocular scissors, and 0.1 mL of triamcinolone acetonide (TAAC) was injected intravitreally. At 1 and 4 weeks and at the sixth month, the patient underwent a complete eye examination, FA, ICGA, and OCT to assess outcomes and complications.


RESULTS
Six months later, BCVA was stable at 20/300, intraocular pressure was 15 mmHg, anterior segment and vitreous cavity were clear without evidence of TAAC granules, and retina was attached. FA and ICGA showed a complete occlusion of the RAP and absence of leakage or ischemia and OCT demonstrated decreased macular thickness with resolution of both intraretinal edema and pigment epithelium detachment, and the restoration of the normal macular profile. At the end of follow-up, the authors did not observe any ocular or systemic complication.


CONCLUSIONS
Surgical approach to RAP stage 3 with intravitreal injection of 4 mg of TAAC was safe and anatomically effective.
Boscia
F
F
Department of Ophthalmology and Otolaryngology, University of Bari, Bari - Italy. francescoboscia@hotmail.com
Furino
C
C
Prascina
F
F
Delle Noci
N
N
Sborgia
L
L
Sborgia
C
C
D000368:Aged; D000798:Angiomatosis / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D003131:Combined Modality Therapy; D003972:Diathermy; D005260:Female; D005451:Fluorescein Angiography; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D007208:Indocyanine Green; D007429:Intraocular Pressure; D008268:Macular Degeneration / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D012161:Retinal Artery / Q000187:drug effects / Q000601:surgery; D015861:Retinal Neovascularization / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D012171:Retinal Vessels / Q000187:drug effects / Q000601:surgery; D041623:Tomography, Optical Coherence; D014222:Triamcinolone Acetonide / Q000627:therapeutic use*; D014792:Visual Acuity; D014821:Vitrectomy
D005938:Glucocorticoids; D014222:Triamcinolone Acetonide; D007208:Indocyanine Green