Efficacy of intravitreal and periocular triamcinolone associated with photodynamic therapy for treatment of retinal angiomatous proliferation

Montero, J A; Ruiz-Moreno, José M.; Sanabria, María R.; Fernandez-Munoz, Marta

doi:10.1136/bjo.2008.141903

Cited by 15 publications

(12 citation statements)

References 29 publications

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“…24,25 Combined therapies may offer better results, especially in case of PDT combined with intravitreal triamcinolone. 26 Finally, the size of our series was limited to 29 eyes of 26 patients. However, the follow-up in this series is one of the longest (12 months) and all eyes were treatment naive.…”

Section: Discussionmentioning

confidence: 99%

Ranibizumab for retinal angiomatous proliferation in age-related macular degeneration

Atmani

Voigt

Tien

et al. 2010

Eye

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Purpose To assess the 1-year functional outcome and to evaluate the morphological changes after intravitreal injections of ranibizumab in eyes affected with retinal angiomatous proliferation (RAP) due to age-related macular degeneration (AMD). Methods A prospective, non-randomized, interventional study was conducted on 26 consecutive patients with newly diagnosed RAP. All eyes were treatment naive and were randomized to receive intravitreal injections of ranibizumab for a 12-month period. After the first three monthly injections, re-treatment was performed in case of best-corrected visual acuity (BCVA) loss of at least five letters associated with fluid within the macula, central macular thickness (CMT) increase of at least 100 lm, and/or persistence of fluid within the macula as evaluated by optical coherence tomography, new onset macular haemorrhages, persistence of leakage from the lesions on fluorescein angiography. Results All patients completed the 12-month follow-up: 25 of the 29 treated eyes (86.2%) were stabilized, with a loss of less than 15 letters. Nineteen eyes (65.5%) maintained or improved their BCVA, and three eyes (10.3%) gained three lines or more. Overall, mean BCVA remained stable at the 12-month follow-up (À0.07 letters; P40.05). Mean CMT significantly decreased from 386 ± 147 to 216 ± 74 lm at the 12-month follow-up. No significant adverse events were observed during the study. The mean number of injections was 5.8±1.7 during the follow-up period. Conclusion The 1-year follow-up outcomes in our series suggest that ranibizumab is an effective treatment for RAP in AMD, allowing stabilization of BCVA and reduction of CMT.

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Section: Discussionmentioning

confidence: 99%

Ranibizumab for retinal angiomatous proliferation in age-related macular degeneration

Atmani

Voigt

Tien

et al. 2010

Eye

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“…However, a higher rate of complications and RAP recurrences was seen in group 3 [109]. Because of the limited effects of antiangiogenic drugs on stage III lesions [56,106,107] and the longer effect of intravitreal steroids in association with PDT, many authors consider that PDT plus IVTA still plays an important role in the treatment of advanced forms of RAP [107]. Another possible treatment for RAP may be a triple therapy with an anti-VEGF agent, PDT, and steroids.…”

Section: Ivta In Retinal Angiomatous Prolife-ration Therapymentioning

confidence: 93%

“…The concentration level that this dose could reach in the subretinal space is still unclear, and there is no substantial agreement between the physicians, about the optimal dose to be injected in the human eye. Some authors reported good results even with lower doses of TA (2 mg-Iwama D 2008) [42] [55][56][57][58][59] with fewer side effects like cataract and glaucoma. Nevertheless, in most trials the effect of TA was transient.…”

Section: Dosagementioning

confidence: 95%

“…At 12 months in the respective groups, mean VA changed from 0.17 to 0.12 Snellen equivalent, from 0.21 to 0.1, and from 0.2 to 0.17. The authors noted that combined IVTA and PDT offered better results [56]. The study of Reche-Frutos et al reported that the disappearance of TA from the vitreous cavity may allow the neovascular stimulus and angiogenic process restart.…”

Section: Ivta In Retinal Angiomatous Prolife-ration Therapymentioning

confidence: 97%

“…The need for diffusion across the sclera and choroid along with the variable rate of steroid dissolution from the particulate suspension make intraocular steroid levels difficult to assess and adjust. Some authors speculate that the eyes treated with sub-Tenon injections, did not show increased IOP either, even after repeated periocular injections of TA, suggesting that the amount of steroid reaching the eye was not enough to achieve any positive or negative effect [56][57][58][59][60][61].…”

Section: Peri-ocular Ta In Cnvmentioning

confidence: 99%

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Clinical Evidence of Intravitreal Triamcinolone Acetonide in the Management of Age-Related Macular Degeneration

Becerra

Morescalchi

Gandolfo

et al. 2011

CDT

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Triamcinolone acetonide (TA) is one of the first pharmacologic compounds evaluated for the treatment of choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD). The most important effects of TA consist in the stabilisation of the blood-retinal barrier and the down-regulation of inflammation. TA also has anti-angiogenic and anti-fibrotic properties. The peculiar characteristic of being well tolerated by ocular tissues and the capability to remain active for many months after a single intravitreal injection, make this drug a safe and effective alternative. In the past decade, intravitreal injection of TA (IVTA) has emerged as a useful treatment of several ocular diseases such as uveitis, macular edema secondary to retinal vasculature disease, neovascularisation and vitreoretinopathy. In this paper, we review all the available evidence of its use in AMD as mono-therapy or in combination with other treatments, and we discuss which role TA will play in the treatment of AMD in the future. The first experiences with IVTA as monotherapy for the treatment of exudative AMD reported a positive outcome in transiently reducing the leakage from CNV. However, in the long-term follow-up, IVTA as monotherapy had no effect on the risk of severe visual acuity loss, despite a significant anti-angiogenic effect found 3 months after the treatment. Consequently, studies using the combination of IVTA and photodynamic therapy (PDT), which acts synergistically, were performed. They reported to improve vision and to reduce the number of re-treatments with PDT. A large number of publications confirmed the positive synergic role of combining TA and PDT (therapies) for the treatment of all types of CNV: classic or predominantly classic, occult or minimally classic and RAP (Retinal Angiomatous Proliferation) lesions. The advantages registered with the use of IVTA plus PDT compared to PDT alone were partially limited by the side effects, such as the rapid evolution of cataract. Nevertheless, cataract surgery may stimulate the development of CNV (result in stimulating CNV). However, in large, randomized, clinical trials on combination therapy of TA and PDT, visual acuity failed to show an improvement, even though the lesion size and subretinal fluid had decreased, compared to controls treated with PDT alone. Some authors reported an increased risk of developing macular atrophy after the combination therapy with IVTA and PDT. Reduction of the PDT fluence rate in association with the use of steroids resulted in reducing the risk of macular atrophy and in a better visual acuity outcome. The introduction of anti-VEGF-based drugs has revolutionized the treatment of AMD and has replaced all the previous therapies used for CNV. Visual improvement becomes an expectation in a higher proportion of patients, previously limited to minimizing vision loss. Anti-VEGF therapy also resulted in superior visual improvement compared to all types of combination therapy with IVT and PDT. Nevertheless, anti-VEGF monotherapy also has many...

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Therapie der retinalen angiomatösen Proliferation im Stadium III

et al. 2012

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Retinal angiomatous proliferation (RAP) is a subtype of exudative age-related macular degeneration which is characterized by an intraretinal origin of the lesion and a particularly poor prognosis. In this retrospective case study 33 eyes from 33 patients with stage III RAP lesions were included and initially treated with 3 intravitreal injections of 0.5 mg ranibizumab at monthly intervals. Criteria for extended treatment were visual deterioration, fresh bleeding, residual fluid or increase of the central retinal thickness in optical coherence tomography (OCT) as well as persisting activity in fluorescence angiography (FLA). The follow-up period was 8 months. The mean best corrected visual acuity (BCVA) increased insignificantly from logMAR 0.71 at the start of therapy to logMAR 0.67 after the first 3 intravitreal treatment injections and remained stable up to 8 months. The mean decrease of the central retinal thickness after 4 months (-90 µm) and after 8 months (-70 µm) was significant. Of the patients included in the study 67 % were treated repeatedly and the mean frequency of reinjections was 2.27 injections after 8 months. The intravitreal injection of ranibizumab in patients with stage III RAP lesions resulted in functional and anatomical stabilization. In most cases repeated treatment is necessary which underlines the urgent need for close surveillance in follow-up.

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Efficacy of intravitreal and periocular triamcinolone associated with photodynamic therapy for treatment of retinal angiomatous proliferation

Abstract: Combined PDT-IT may offer better results than PDT monotherapy or PDT-PT in patients with RAP stage III.

Cited by 15 publications

References 29 publications

Ranibizumab for retinal angiomatous proliferation in age-related macular degeneration

Ranibizumab for retinal angiomatous proliferation in age-related macular degeneration

Clinical Evidence of Intravitreal Triamcinolone Acetonide in the Management of Age-Related Macular Degeneration

Therapie der retinalen angiomatösen Proliferation im Stadium III

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