Abstract
Purpose: :
To evaluate the effectiveness of and report the outcomes of combination therapy consisting of intravitreal triamcinolone acetonide (TA) and photodynamic therapy (PDT) in the treatment of a small subset of patients with RAP.
Methods: :
This is a retrospective clinical chart review of data collected from 19 eyes of 16 patients with RAP.
Results: :
The total follow up time period for the 19 eyes ranged from 3 months to 22 months (average 8.8 months). 31.6% (6/19) of eyes have had resolution of the RAP lesion and have been followed an average of 6 months since initial treatment. 68.4% (13/19) of the eyes had clinical and angiographic evidence of recurrence requiring retreatment at an average of 4.4 months after initital treatment. 3 of the 13 eyes received combination therapy as a second treatment. 7 of the 13 eyes received PDT alone as a second treatment, and 2 eyes opted to hold off on retreatment. 63.6% (7/11) of eyes that received a second treatment had 2 or more recurrences necessitating a third or fourth treatment with combination therapy, PDT alone, or TA alone. Of the eyes that had combination treatment as either a second or third treatment, 60% (3/5) had recurrence at an average of 5.3 months. The eyes that had PDT alone as a second or third treatment had a recurrence rate of 50% (7/14) occurring at 2.8 months. 72.7% (8/11) of the retreated eyes are currently in the resolution phase with an average of 4.4 months since the last treatment. Average decimal visual acuity prior to treatment was 0.284 (20/70). 73.7% (14/19) of eyes had an improvement in visual acuity averaging 0.437 (20/46) at 1–3 months. These results remained stable in patients without recurrences. However, the visual acuity progressively worsened in patients in which leakage recurred. Final decimal visual acuity at the last documented visit was averaged at 0.285 (20/70).
Conclusions: :
Combination therapy consisting of intravitreal triamcinolone acetonide and photodynamic therapy in the treatment of RAP appears to be effective in short term suppression of lesions. Combination therapy as a second or third treatment for recurrences offers a longer resolution phase than retreatment done with PDT alone. Visual acuity generally improves within the first three months after treatment. This remains stable in patients with complete resolution but decreases in patients with recurrence of leakage. Larger randomized controlled trials need to be done to adequately assess the effectiveness of combination therapy versus conventional treatment such as PDT or laser photocoagulation in the treatment of RAP.
Keywords: age-related macular degeneration