title: Sequenced combined intravitreal triamcinolone and indocyanine green angiography-guided photodynamic therapy for retinal angiomatous proliferation.
abstract: OBJECTIVE
  To study sequenced combined therapy using intravitreal triamcinolone acetonide followed by photodynamic therapy for the treatment of retinal angiomatous proliferation.
  
  
  METHODS
  Patients newly diagnosed as having retinal angiomatous proliferation underwent intravitreal triamcinolone injection to reduce intraretinal and subretinal exudation, followed 7 to 14 days later by indocyanine green angiography-guided photodynamic therapy with verteporfin. Complete ocular examination, fluorescein angiography, indocyanine green angiography, and optical coherence tomography were performed at baseline and at standard intervals thereafter.
  
  
  RESULTS
  Twenty-seven eyes of 26 patients underwent this sequenced combined treatment and were followed up for 12 months. The triamcinolone injection reduced the cystoid edema before photodynamic therapy. Complete resolution of the angiographic leakage was achieved in 89% of eyes. Visual acuity improved in 37% and was stable in 52% of eyes. Eight eyes developed recurrent leakage after 3 to 11 months. Complete resolution of leakage was observed after subsequent treatment.
  
  
  CONCLUSIONS
  This sequenced combined treatment in patients with retinal angiomatous proliferation was effective in reducing or eliminating the edema, achieving rapid regression of neovascularization, and stabilizing or improving visual acuity. To our knowledge, no study to date has achieved such promising results in the management of retinal angiomatous proliferation. A randomized clinical trial is under way to compare sequential and simultaneous combined therapy.
authors.affiliation: LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, NY 10021, USA. vrmny@aol.com
authors.forename: K Bailey
authors.initials: KB
authors.lastname: Freund
authors.forename: Christina M
authors.initials: CM
authors.lastname: Klais
authors.forename: Chiara M
authors.initials: CM
authors.lastname: Eandi
authors.forename: Michael D
authors.initials: MD
authors.lastname: Ober
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Goldberg
authors.forename: John A
authors.initials: JA
authors.lastname: Sorenson
authors.forename: Lawrence A
authors.initials: LA
authors.lastname: Yannuzzi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000798:Angiomatosis / Q000175:diagnosis / Q000188:drug therapy*; D004396:Coloring Agents; D003131:Combined Modality Therapy; D005260:Female; D005451:Fluorescein Angiography; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D007208:Indocyanine Green; D007267:Injections; D008269:Macular Edema / Q000175:diagnosis / Q000188:drug therapy; D008297:Male; D010778:Photochemotherapy; D017319:Photosensitizing Agents / Q000627:therapeutic use; D010865:Pilot Projects; D011166:Porphyrins / Q000627:therapeutic use; D011446:Prospective Studies; D012008:Recurrence; D015861:Retinal Neovascularization / Q000175:diagnosis / Q000188:drug therapy*; D041623:Tomography, Optical Coherence; D014222:Triamcinolone Acetonide / Q000627:therapeutic use*; D000077362:Verteporfin; D014792:Visual Acuity; D014822:Vitreous Body
chemical_list: D004396:Coloring Agents; D005938:Glucocorticoids; D017319:Photosensitizing Agents; D011166:Porphyrins; D000077362:Verteporfin; D014222:Triamcinolone Acetonide; D007208:Indocyanine Green