Combined Treatment of Retinal Angiomatous Proliferation (RAP) With Intravitreal Triamcinolone Acetonide (IVTA) and Photodynamic Therapy (PDT): A Pilot Study Comparing 20 mg vs 4 mg

Abstract

Purpose:: To prospectively compare the effectiveness of 20 vs 4 mg IVTA in the combined treatment (IVTA and PDT) of RAP.

Methods:: Forty-six patients (51 eyes) newly diagnosed as having RAP were recruited in 3 different Eye Clinics and underwent IVTA followed 7 days later by PDT. 2 Centres (32 eyes) injected 20 mg of TA, 1 Centre (19 eyes) injected 4 mg. For all the patients, complete ocular examination, dynamic fluorescein and indocyanine green angiographies were performed at the baseline and planned at month 3, 6, 12 and 18 after the treatment. Any other concomitant ocular disease was considered an exclusion criteria. The only allowed re-treatment was PDT; any intravitreal injective therapy during the follow-up caused a discontinuation from the study.

Results:: At the moment, the follow-up period for the 51 eyes ranges from 6 months to 18 months (average: 10.17 months). At the baseline, mean ( ± SD ) visual acuity was 0.28 ± 0.19 and 0.25 ± 0.19 in the 20 mg and 4 mg groups respectively (P=0.606; t-test). Month 3, month 6 and last visit visual acuity was respectively 0.27 ± 0.18, 0.27 ± 0.2 and 0.22 ± 0.16 in the 20 mg group and respectively 0.29 ± 0.17, 0.29 ± 0.18 and 0.27 ± 0.19 in the 4 mg group, with no significant differences among the different visits (P=0.549; ANOVA) and between the two groups (P=0.344; ANOVA). Visual acuity improved in 12% vs 21% and was stable in 56% vs 53% of eyes in the 20 vs 4 mg groups respectively.In the 20 and 4 mg groups respectively 59% (19/32) and 42% (8/19) of eyes showed a regression of RAP at all the follow-up visits, without any re-treatment.

Conclusions:: In the short-medium term, intravitreal injection of 20 mg seems to be more effective in achieving regression of RAP; however 20 vs 4 mg of TA didn’t show different effects on visual acuity in the combined treatment of RAP. These preliminary results warrant a more detailed prospective clinical trial.

Keywords: age-related macular degeneration • injection • photodynamic therapy