Macular atrophy after combined intravitreal triamcinolone acetonide (IVTA) and photodynamic therapy (PDT) for retinal angiomatous proliferation (RAP).
BACKGROUND
Retinal angiomatous proliferation (RAP) is a variant of exudative AMD that appears to respond poorly to standard PDT. This pilot study explores the potential efficacy and safety of combined intravitreal triamcinolone acetonide (IVTA).


METHODS
In a prospective interventional case series 10 eyes of 8 patients with RAP were treated with combined IVTA/PDT.


RESULTS
After 3 months there was no evidence of significant exudative activity in 7/10 eyes treated with IVTA/PDT, three eyes required re-treatment. After 6 months 4/10 eyes were "dry" on fluorescein angiography, visual acuity was stable (loss of less than 3 Snellen lines) or had improved in 5/10 eyes. 5/10 eyes had lost 3 or more lines, due to central macular atrophy in 4/5 eyes and secondary to a progressive exudative lesion in 1/5 eyes.


CONCLUSIONS
Intravitreal steroids combined with PDT appear to be a step ahead in the treatment of RAP. Our results, however, raise the question whether combined treatment may create more atrophy leading to vision loss in some cases.
Sutter
F K
FK
Augenklinik, UniversitätsSpital Zürich, Zürich, Switzerland. Florian.Sutter@usz.ch
Kurz-Levin
M M
MM
Fleischhauer
J
J
Bösch
M M
MM
Barthelmes
D
D
Helbig
H
H
D000368:Aged; D000798:Angiomatosis / Q000150:complications / Q000188:drug therapy*; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D003131:Combined Modality Therapy; D004338:Drug Combinations; D005260:Female; D006801:Humans; D007267:Injections / Q000379:methods; D008268:Macular Degeneration / Q000139:chemically induced* / Q000175:diagnosis; D008297:Male; D010778:Photochemotherapy / Q000379:methods*; D011446:Prospective Studies; D015861:Retinal Neovascularization / Q000150:complications / Q000188:drug therapy*; D018570:Risk Assessment; D012307:Risk Factors; D017211:Treatment Failure; D016896:Treatment Outcome; D014222:Triamcinolone Acetonide / Q000008:administration & dosage*
D000893:Anti-Inflammatory Agents; D004338:Drug Combinations; D014222:Triamcinolone Acetonide