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Y. Fujii, S. Ooto, H. Tamura, K. Yamashiro, A. Otani, A. Tsujikawa, N. Yoshimura; Photodynamic Therapy Combined With Intravitreal Bevacizumab and Intravitreal Triamcinolone for the Treatment of Retinal Angiomatous Proliferation. Invest. Ophthalmol. Vis. Sci. 2010;51(13):925.
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To evaluate the efficacy of triple therapy with intravitreal bevacizumab (IVB) and intravitreal triamcinolone (IVT), administered several days after the initiation of photodynamic therapy (PDT) in patients with retinal angiomatous proliferation (RAP).
We conducted a pilot study involving consecutive treatment-naïve patients who were recently diagnosed with RAP at Kyoto University Hospital. At baseline, IVB (1.25 mg ) and IVT (4 mg) were injected. After 3-4 days, PDT was administered. The best-corrected visual acuity (BCVA) was determined; intraocular pressure was measured; and fundus examination, spectral-domain optical coherence tomography (SD-OCT), fluorescein angiography (FA), and indocyanine angiography were performed at baseline and at 3-month intervals. Treatment was repeated if the BCVA reduced or the angiographic or SD-OCT findings worsened.
The study involved 8 eyes of 8 patients. The follow-up duration was ≥12 months for all patients (mean, 16.5 months). Three eyes had stage 2 RAP, and 5 eyes had stage 3 RAP. The mean logMAR VA was 0.99 at baseline and stable after 12 months (0.90; P = 0.491). SD-OCT revealed elimination of the subretinal fluid, intraretinal cystic spaces, and pigment epithelial detachment (PED) in each eye. In 4 eyes, the central macular thickness decreased by more than 100 micrometer. Among the eyes with stage 2 RAP, the BCVA remained stable in 2 eyes (66.7%) and reduced in 1 eye (33.3%). Among the eyes with stage 3 RAP, it improved in 2 eyes (40%) and remained stable in 3 eyes (60%). In 1 eye with stage 3 RAP, recurrent leakage was observed after 7--12 months of follow-up. This eye was treated with the same combined therapy, and FA subsequently revealed complete resolution of the leakage.
Combined treatment with PDT, IVB, and IVT was effective for patients with RAP of stage 2 or 3: this treatment resolved the subretinal fluid accumulation, intraretinal cystic spaces, and PED and stabilized the VA.
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