Retinal Angiomatous Proliferation Reactivation 6 Months after High-Dose Intravitreal Acetonide Triamcinolone and Photodynamic Therapy

Abstract

Combined therapy using high-dose IVTA and PDT is beneficial in stabilizing RAP. However, a high incidence of RAP reactivation has been observed at 6 months, even with a high-dose IVTA injection.

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

“…The difference was no longer significant at 6, 9 and 12 months. These results suggest that the disappearance of TA from the vitreous cavity may allow the neovascular stimulus and angiogenic process to restart, as has been reported by Reche-Frutos et al 20. It is notable that decreased fluorescein leakage was more common at all time intervals in patients treated by combined PDT–IT (58–71% of the cases) than in patients treated by PDT monotherapy (31–50%) or PDT–PT (33–38%), reducing the need for re-treatment after PDT–IT (table 2).…”

Current treatment options for retinal angiomatous proliferans (RAP)

“…The mean change of visual acuity was +6 ETDRS at 3 months, +10 ETDRS at 6 months and +5 ETDRS letters at 12 months follow-up. Most of the studies report stabilisation by 6 months although IVTA is also associated with increased incidence of raised pressure and cataract formation 28 32 34 35…”

Intravitreal ranibizumab (Lucentis®) in the treatment of retinal angiomatous proliferation (RAP)

“…Various treatment modalities have been used in the treatment of RAP, including direct laser photocoagulation, transpupillary thermotherapy, surgical removal, and photodynamic therapy (PDT) with verteporfin (Visudyne; Novartis Pharma AG, Basel, Switzerland) with or without concomitant intravitreal triamcinolone [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22]. However, often their results were disappointing, leading to limited success or to poor functional results, while in some cases concerns were aroused with regard to risks of severe complications [5,16,17].…”