Remodeling of the vascular channels in retinal angiomatous proliferations treated with intravitreal triamcinolone acetonide and photodynamic therapy.
BACKGROUND
The objective was to describe the remodeling of the vascular channels in stage II retinal angiomatous proliferation (RAP) treated by intravitreal injections of triamcinolone acetonide (TA) and subsequent photodynamic therapy (PDT).


METHODS
Stage II RAP secondary to age-related macular degeneration was documented by dynamic digital fluorescein and indocyanine green angiography in 3 consecutive patients (3 eyes). All eyes were treated with intravitreal injection of TA (4 mg, 0.1 ml) followed by PDT 5-10 days later.


RESULTS
Indocyanine green angiography (ICGA) revealed a complete remodeling of the vascular structure of the three RAPs after treatment. The feeding retinal artery, which shunted a major part of the blood flow from the original arteriole toward the intraretinal neovascular complex before treatment, regained a normal appearance after treatment. With RAP closure, the blood flow was again directed through the original retinal arteriole, and the connection to the RAP was no longer visible.


CONCLUSIONS
Stage II RAPs are difficult lesions to treat. A real remodeling of the vascular lesion is achieved with the combined use of intravitreal TA and PDT. This finding corroborates the need for randomized clinical trials currently under way to evaluate this combination treatment in wet, age-related macular degeneration.
Bottoni
Ferdinando
F
Department of Ophthalmology, San Giuseppe Hospital, Milan, Italy. ferdinando.bottoni@fastwebnet.it
Romano
Mary
M
Massacesi
Amedeo
A
Bergamini
Fulvio
F
D000368:Aged; D000369:Aged, 80 and over; D004396:Coloring Agents; D004359:Drug Therapy, Combination; D005260:Female; D005451:Fluorescein Angiography; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D007208:Indocyanine Green; D007267:Injections; D008268:Macular Degeneration / Q000150:complications; D008297:Male; D010778:Photochemotherapy; D012039:Regional Blood Flow / Q000502:physiology; D015861:Retinal Neovascularization / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology*; D012171:Retinal Vessels / Q000502:physiology*; D014222:Triamcinolone Acetonide / Q000627:therapeutic use*; D014822:Vitreous Body
D004396:Coloring Agents; D005938:Glucocorticoids; D014222:Triamcinolone Acetonide; D007208:Indocyanine Green