MICROPULSED LASER PHOTOCOAGULATION AND INTRAVITREAL TRIAMCINOLONE ACETONIDE INJECTION FOR THE TREATMENT OF RETINAL ANGIOMATOUS PROLIFERATION

Abstract

To investigate visual acuity and fluorescein angiographic outcomes, as well as adverse events, associated with treatment of retinal angiomatous proliferation (RAP) with micropulsed laser photocoagulation and intravitreal triamcinolone acetonide injection. In this retrospective, noncomparative, interventional, consecutive case series, the medical records of all patients treated for RAP with micropulsed laser photocoagulation (yellow or green dye; duration, 0.02-0.05 second; power adjusted to achieve a white burn of moderate intensity at the level of the RAP lesion in the retina) and intravitreal triamcinolone acetonide (4 mg/0.1 mL) injection between January 2003 and November 2004 were reviewed by one of four retina specialists at a single retina practice. Main outcome measures were visual acuity, leakage shown by fluorescein angiography, and adverse events. The study included 14 eyes of 13 patients (8 women and 5 men; median age, 83 years [range, 70-90 years]). Triamcinolone acetonide injection preceded laser treatment by a median duration of 7 days (range, 5-16 days) in 8 eyes, was performed on the same day as laser treatment in 2 eyes, and followed laser treatment by a median duration of 7 days (range, 7-28 days) in 4 eyes. Eyes were followed a median of 18 months (range, 12-27 months) after treatment with both laser and intravitreal triamcinolone injection. Compared with pretreatment visual acuity, vision at 12 months and the last follow-up examination was stable in 5 eyes (36%), improved by >or=2 lines in 6 eyes (43%), and worsened by >or=2 lines in 3 eyes (21%). The median visual acuity before treatment was 20/200 compared with 20/80 at 3 months after treatment (P = 0.02), 20/100 at 6 months after treatment (P = 0.16), 20/200 at 12 months after treatment (P = 0.73), and 20/100 (P = 0.63) at the last follow-up examination. For 13 eyes (93%), fluorescein angiography performed 6 months after administration of both laser and intravitreal triamcinolone injection demonstrated resolution of all leakage; one eye was treated with photodynamic therapy with verteporfin 6 months after treatment for persistent low-grade leakage. Elevated intraocular pressure (>25 mm Hg) occurred in 2 eyes at 2.5 months and 2 months after intravitreal triamcinolone acetonide injection; both eyes were treated with transient use of antiglaucoma eyedrops. Seven (78%) of 9 phakic eyes had cataract progression, and 5 of these 7 eyes underwent cataract extraction during the follow-up period. No other adverse events occurred. Micropulsed laser photocoagulation and intravitreal triamcinolone acetonide injection may be effective and safe treatment for RAP lesions.