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I. Ashfaq, M.F. El–Ashry, S. Mirza, S. Pagliarini; Retinal Angiomatous Proliferation: Treatment Outcomes Using Different Modalities . Invest. Ophthalmol. Vis. Sci. 2006;47(13):5180.
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© ARVO (1962-2015); The Authors (2016-present)
Retinal Angiomatous Proliferation (RAP) is a term describing an aggressive entity or subset of exudative age–related macular degeneration. Treatment options are largely experimental with poor prognosis to central vision. The purpose was to illustrate some of the available treatment options and their outcomes in a series of patients with RAP.
In this observational retrospective study 12 patients with stage 1–2 RAP (13 eyes), 6 males and 6 females, aged 69–87 years (mean 72, median 79) were treated. Patients were evaluated with biomicroscopic examination , stereo fluorescein and Indocyanine green (ICG) angiography and Optical Coherence Tomography (OCT). Treatment modalities included laser photocoagulation in 3 patients (4 eyes), intra–vitreal triamcinolone acetonide (IVTA) injection (4mg) combined with laser photocoagulation in 7 patients (7 eyes), photodynamic therapy (PDT) alone in one eye of one patient, or PDT combined with IVTA in one eye of one patient. Successful functional outcome was defined as an improvement or stabilisation of LogMar visual acuity (±1 line). Anatomical improvement was defined as regression of RAP, judged by the disappearance of hotspot/s on ICG, resolution of oedema/ pigment epithelial detachment on OCT, and of haemorrhages, exudates and oedema clinically. Patients were followed up for an average of 18 months.
Six eyes who underwent IVTA and laser showed stability or improvement of visual acuity with RAP regression for an average of 6 months (range 3–11 months), whilst 1 eye progressively lost vision despite an apparent initial RAP resolution. In the laser only group, 1 patient had stable vision for 12 months but without anatomical resolution, and 2 patients (3 eyes) had functional and anatomical improvement but for 4 months only. RAP recurred in all these eyes. The patient treated with PDT had progressive and severe decline of visual acuity. The patient who had IVTA + PDT retained stable vision for longer than 7 months. No significant complications were encountered.
Laser photocoagulation, especially if combined with IVTA, can achieve visual improvement or stabilisation as well resolution of early RAP though only for a short period. We endeavour to expand our PDT + IVTA series to ascertain if it produces a more durable benefit than IVTA + laser photocoagulation.
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