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A. Van De Moere, S.S. Sandhu, R. Kak, S.J. Talks; Anatomical and Visual Outcome of Retinal Angiomatous Proliferation (RAP) Lesions Treated With PDT and Intravitreal Triamcinolone Acetonide . Invest. Ophthalmol. Vis. Sci. 2005;46(13):314.
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Purpose: To assess anatomical and visual outcome of Retinal Angiomatous Proliferation (RAP) lesions related to Age Related Macular Degeneration (AMD) treated with intravitreal injection of triamcinolone acetonide (TAAC) and photodynamic therapy (PDT). Methods: In a prospective, consecutive, interventional case series from one center, we included 11 eyes of 11 patients with RAP related to AMD. Each patient was given an intravitreal injection of 0.1ml TAAC 40mg/ml combined with initial PDT with review at 1 month and then every 3 months. Main outcome measures were changes in best–corrected visual acuity (BCVA), fluorescein angiography (FA), Indocyanine Green angiography (ICGA) using the Heidelberg Retina Angiograph (HRAII), Optical Coherence Tomography (OCT), number of treatments, intraocular pressure (IOP). Results: Median BCVA at baseline was 57 LogMAR letters (standard deviation = 11 LogMAR letters). At baseline, all patients showed superficial retinal dot haemorrhages. Baseline OCT showed cystoid macular edema (CME) in all eyes, subretinal fluid (SRF) in 6 eyes, and pigment epithelial detachment (PED) in 6 eyes. Baseline FA showed foveal late leak in all eyes. ICGA was consistent with RAP. Median BCVA at 3, 6 and 9 months was 63, 63, and 70 LogMar letters respectively with a median gain of 7, 7 and 11 LogMAR letters respectively. At 3 months, all eyes showed a near–normal foveal depression, without evidence of SRF or CME. No patient was retreated at 3 months. At 6 months, reappearance of CME was seen in 1 eye, which was retreated with PDT and intravitreal TAAC. At 9 months again, reappearance of CME was seen in 3 patient, who were retreated with the same regime. IOP rose above 22 mmHg in 3 patients, which was well controlled with topical treatment. Conclusions: At 3 months from baseline, complete resolution of CME with restoration of foveal depression is seen in all eight patients with RAP when treated with intravitreal injection of TAAC and PDT. At 3, 6 and 9 months, a gain in visual acuity is seen. From 6 months onwards, a small tendency towards recurrence of CME is seen requiring repeat treatment.
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