The role of dynamic indocyanine green angiography in the diagnosis and treatment of retinal angiomatous proliferation.
OBJECTIVE
We compared the effectiveness and durability of indocyanine green angiography (ICG) directed focal thermal laser treatment of the afferent arteriole in the treatment of retinal angiomatous proliferation (RAP).


METHODS
Sixteen consecutive patients presenting with stage I or II RAP lesions underwent optical coherence tomography, fluorescein angiography and dynamic ICG examination and were evaluated for response to treatment. Two groups were evaluated: focal laser as initial treatment; and focal laser as salvage treatment after recurrence with photodynamic therapy (PDT) and intravitreal triamcinolone. Five additional eyes with stage III RAP were evaluated separately.


RESULTS
Seven eyes received focal laser as initial treatment, and nine eyes received focal laser as salvage treatment after failure of PDT with triamcinolone. Five of seven eyes in the initial focal laser group demonstrated resolution of oedema. All five of the responders recurred (mean 4.4 months). Salvage therapy with PDT and triamcinolone after focal laser failure transiently closed these recurrences. In contrast, eight of nine eyes receiving thermal ablation of the RAP lesion after recurrence from prior PDT/triamcinolone demonstrated initial improvement of the retinal oedema. Four eyes demonstrated no recurrence within a year. None of the five eyes with stage III RAP improved anatomically or visually.


CONCLUSIONS
Focal thermal laser treatment of RAP arteriole can resolve retinal oedema. However, durability was longer in eyes with prior PDT and triamcinolone treatment than those receiving thermal laser as initial therapy. These results suggest that focal laser may be useful in treatment of RAP recurrences and that combination therapy with PDT/triamcinolone plus focal laser is better than focal laser alone.
Bearelly
S
S
Duke Center for Macular Diseases, Duke University Eye Center, Box 3802 Erwin Road, Durham, NC 27710, USA.
Espinosa-Heidmann
D G
DG
Cousins
S W
SW
D000368:Aged; D000798:Angiomatosis / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery*; D004396:Coloring Agents; D003131:Combined Modality Therapy; D005260:Female; D005451:Fluorescein Angiography; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007208:Indocyanine Green; D017075:Laser Coagulation / Q000379:methods*; D008268:Macular Degeneration / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery*; D008297:Male; D010778:Photochemotherapy; D012008:Recurrence; D015861:Retinal Neovascularization / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery*; D016879:Salvage Therapy / Q000379:methods; D041623:Tomography, Optical Coherence; D017211:Treatment Failure; D016896:Treatment Outcome; D014221:Triamcinolone / Q000627:therapeutic use
D004396:Coloring Agents; D005938:Glucocorticoids; D014221:Triamcinolone; D007208:Indocyanine Green