Background
The objective was to describe the remodeling of the vascular channels in stage II retinal angiomatous proliferation (RAP)
treated by intravitreal injections of triamcinolone acetonide (TA) and subsequent photodynamic therapy (PDT).
Methods
Stage II RAP secondary to age-related macular degeneration was documented by dynamic digital fluorescein and indocyanine green
angiography in 3 consecutive patients (3 eyes). All eyes were treated with intravitreal injection of TA (4 mg, 0.1 ml) followed
by PDT 5–10 days later.
Results
Indocyanine green angiography (ICGA) revealed a complete remodeling of the vascular structure of the three RAPs after treatment.
The feeding retinal artery, which shunted a major part of the blood flow from the original arteriole toward the intraretinal
neovascular complex before treatment, regained a normal appearance after treatment. With RAP closure, the blood flow was again
directed through the original retinal arteriole, and the connection to the RAP was no longer visible.
Conclusions
Stage II RAPs are difficult lesions to treat. A real remodeling of the vascular lesion is achieved with the combined use of
intravitreal TA and PDT. This finding corroborates the need for randomized clinical trials currently under way to evaluate
this combination treatment in wet, age-related macular degeneration.
Keywords Age-related macular degeneration - Retinal angiomatous proliferation - Triamcinolone acetonide - Photodynamic therapy