Sequenced Combined Intravitreal Triamcinolone and Indocyanine Green Angiography–Guided Photodynamic Therapy for Retinal Angiomatous Proliferation

Freund, K. Bailey; Klais, Christina M.; Eandi, Chiara M.; Ober, Michael D.; Goldberg, Daniel E.; Sorenson, John A.; Yannuzzi, Lawrence A.

doi:10.1001/archopht.124.4.487

Cited by 69 publications

(53 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Only some authors have described post-therapeutic visual loss associated with this treatment modality, whereas most authors report a higher rate of stabilization of both BCVA and morphological changes. 18,19,33 We can confirm these results of significant stabilization of vision during a follow-up period of 24 weeks. Nevertheless, the rate of RPE ruptures still remained high.…”

Section: Discussionsupporting

confidence: 72%

Serous pigment epithelial detachment in age-related macular degeneration: comparison of different treatments

Lommatzsch

Heimes

Gutfleisch

et al. 2009

Eye

View full text Add to dashboard Cite

Aims To investigate the therapeutic effects of different treatments on serous pigment epithelium detachment (PED) in age-related macular degeneration (AMD). Methods A total of 328 patients suffering from serous PED in AMD were retrospectively analysed. We treated only patients with documented visual deterioration: 86 patients with bevacizumab, 128 with ranibizumab, 60 with pegaptanib, and 54 with photodynamic therapy (PDT) combined with intravitreal triamcinolone acetonide (IVTA). Bestcorrected vision was determined in the logarithm of the minimal angle of resolution (logMAR). We also analysed morphological findings such as full foveal thickness by optical coherence tomography (OCT), manually calculated height of PED as measured by OCT, and fluorescence angiography. Results The mean follow-up was 42.4 weeks. The best-corrected visual acuity of 0.78 logMAR before treatment could be improved by about 0.066 logMAR after treatment. Retinal thickness decreased in all patients with PED, in the mean by about 64.06 lm, and the mean value of the manually calculated height decreased by about 0.98 units. All functional and morphological results proved to be significantly better after injection of ranibizumab and bevacizumab than after pegaptanib and the combined treatment with PDT and IVTA. In all, 41 (12.5%) of our patients developed a tear of the retinal pigment epithelium (RPE). Conclusion The therapeutic results were significantly better in patients treated with bevacizumab and ranibizumab than in those treated with pegaptanib or with a combination of PDT and IVTA. Even with treatment, tears of the RPE or only a partial flattening of the PED always indicated a worse prognosis in eyes with exudative AMD than in eyes with classic choroidal neovascularization.

show abstract

Section: Discussionsupporting

confidence: 72%

Serous pigment epithelial detachment in age-related macular degeneration: comparison of different treatments

Lommatzsch

Heimes

Gutfleisch

et al. 2009

Eye

View full text Add to dashboard Cite

show abstract

“…4 A range of alternative treatment options have been reported in case series with limited evidence of efficacy. [5][6][7][8][9][10] No randomized controlled data have been published to date; the prognosis of RAP is currently considered to be poor.…”

Section: Introductionmentioning

confidence: 99%

Incidence of neovascularization in the fellow eye of patients with unilateral retinal angiomatous proliferation

Campa

Harding

Pearce

et al. 2010

Eye

View full text Add to dashboard Cite

Aims The aim of this study is to describe the incidence and characteristics of neovascularization in the fellow eye of patients with retinal angiomatous proliferation (RAP). Methods This is a retrospective study conducted on all patients with a diagnosis of unilateral RAP commencing treatment in a single centre between November 2002 and January 2010. Clinical biomicroscopic examination, fluorescein angiography, and if required, indocyanine green angiography, and optical coherence tomography were used to evaluate all patients. Results In all, 37 patients had a follow-up of X1 year, 28 X2 years, and 11 X3. Patients who developed RAP in the fellow eye were: 2 of 37 (5.4%) within 1 year of follow-up, 4 of 28 (14.2%) within 2 years, and 4 of 11 (36.3%) within 3 years. Conclusion In our case series, the risk of neovascularization in the fellow eye of patients with unilateral RAP increased with time. Approximately one-third of patients with a 3-year follow-up developed a bilateral disease. Our findings warrant further large-scale investigation.

show abstract

“…[5][6][7][8][9][10] Recently, promising results with sequential combined treatment with intravitreal triamcinolone and photodynamic therapy (PDT) were reported, but complications were common. 11,12 Only few uncontrolled studies reporting short-term experience with intravitreal injection of anti-vascular endothelial growth factor (VEGF) in RAP are available in the literature. They show favourable outcomes but frequent intravitreal injections are expected.…”

Section: Introductionmentioning

confidence: 99%

“…To resolve intraretinal oedema and therefore decrease the leakage of verteporfin into the cystoids spaces, intravitreal injection of triamcinolone followed by PDT has also been tried, showing promising results. 11,12 However, some investigators observed that such procedures may be associated with significant atrophy of the RPE and choriocapillaris in patients who developed recurrent exudation requiring re-treatments. 13,17,21,22 In addition, retinal toxicity of intravitreal triamcinolone cannot be entirely ruled out.…”

mentioning

confidence: 99%

Sequential combined treatment with intravitreal bevacizumab and photodynamic therapy for retinal angiomatous proliferation

Viola

Mapelli

Carducci

et al. 2010

Eye

View full text Add to dashboard Cite

Purpose To study visual and anatomical outcomes of sequenced combined therapy using intravitreal bevacizumab followed by photodynamic therapy (PDT) in eyes with retinal angiomatous proliferation (RAP). Safety and rate of intravitreal injections were also evaluated. Methods We conducted a prospective non-comparative pilot study of consecutive patients newly diagnosed with RAP. PDT guided by indocyanine green (ICG) angiography was applied 8±2 days after the intravitreal bevacizumab (1.25 mg) injection. At baseline and every month after the injection, best-corrected visual acuity (BCVA) measurement, complete eye examination including dynamic fluorescein and ICG angiography, and optical coherence tomography (OCT) were performed. Results In all, 21 eyes of 18 patients with RAP were enrolled. The mean age was 77 (range 65-86) years. Mean visual acuity at baseline was 0.63 ± 0.25 logMAR. After treatment BCVA showed no statistically significant differences between each visit (P ¼ 0.10, ANOVA). At 9 months, the BCVA improved by three or more lines in three eyes (14%), remained stable in twelve eyes (57%), and worsened in six eyes (29%). Foveal thickness decreased significantly between baseline and all the follow-up visits (Po0.01, ANOVA). A total of 36 intravitreal injections were given during the study with a mean of 1.7 injections per eye (range 1-3 injections per eye). No ocular or systemic adverse events were reported.Conclusion A possible synergistic effect may arise from the combination of intravitreal bevacizumab with PDT for the treatment of RAP. These findings also suggest a possible benefit of combo therapy in the rate of intravitreal re-injections.

show abstract

Sequenced Combined Intravitreal Triamcinolone and Indocyanine Green Angiography–Guided Photodynamic Therapy for Retinal Angiomatous Proliferation

Cited by 69 publications

References 33 publications

Serous pigment epithelial detachment in age-related macular degeneration: comparison of different treatments

Serous pigment epithelial detachment in age-related macular degeneration: comparison of different treatments

Incidence of neovascularization in the fellow eye of patients with unilateral retinal angiomatous proliferation

Sequential combined treatment with intravitreal bevacizumab and photodynamic therapy for retinal angiomatous proliferation

Contact Info

Product

Resources

About