Treatment of Retinal Angiomatous Proliferation with a Combination of Micropulsed Laser Photocoagulation and Intravitreal Triamcinolone

Abstract

Abstract: : Purpose: Retinal angiomatous proliferation (RAP) is a newly recognized manifestation of exudative age–related macular degeneration that has a poor natural history and has demonstrated resistance to treatment with conventional laser photocoagulation and photodynamic therapy. We studied the efficacy of treating RAP lesions with a combination of focal, micropulsed thermal laser photocoagulation and intravitreal triamcinolone. Methods: Six eyes of five patients presenting with choroidal neovascularization characterized by retinal angiomatous proliferation (RAP) clinically and on fluorecein angiography (FA) were treated. The identified RAP lesion spared the central fovea in all cases. Laser treatment consisted of a micropulsed, yellow or green dye laser, for a duration of 0.01–0.05 seconds to the RAP site identified by FA. Steroid treatment consisted of a single intravitreal injection of 4 mg of triamcinolone through the pars plana under sterile conditions performed 1 to 4 weeks after laser photocoagulation. In two eyes, the triamcinolone injection preceded the laser treatment. Results:Compete inactivity of the choroidal neovascularization and resolution of the subretinal fluid was seen in all six eyes. Snellen visual acuity remained the same in four eyes, improved by 2 lines in one eye and improved by 5 lines in one eye. In two eyes, 3 sessions of laser treatments to the RAP site were necessary. Conclusions:A combination of intravitreal triamcinolone and focal, micropulsed thermal laser appears to be an effective treatment modality for RAP lesions, that often respond poorly to other forms of treatment.

Keywords: age–related macular degeneration • choroid: neovascularization • laser