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Combined surgical ablation and intravitreal triamcinolone acetonide for retinal angiomatous proliferation
F Boscia1, C Furino, F Prascina
1Department of Ophthalmology and Otolaryngology, University of Bari, Bari - Italy. francescoboscia@hotmail.com
Purpose:
Neovascular age-related macular degeneration (ARMD) with retinal angiomatous proliferation (RAP) has a poor natural history and the efficacy of any treatment has not yet been established. The authors describe a combined surgical treatment.
Methods:
A 76-year-old woman presented with a best-corrected visual acuity (BCVA) of 20/600 in the right eye and macula with stage 3 RAP as identified by fluorescein angiography (FA), indocyanine green angiography (ICGA), and optical coherence tomography (OCT). After a standard three-port pars plana core vitrectomy (PPV), endodiathermy of the arteriolar and venous feeder vessels of each lesion was performed, intraretinal RAP feeder vessels were cut with manual vertical intraocular scissors, and 0.1 mL of triamcinolone acetonide (TAAC) was injected intravitreally. At 1 and 4 weeks and at the sixth month, the patient underwent a complete eye examination, FA, ICGA, and OCT to assess outcomes and complications.
Results:
Six months later, BCVA was stable at 20/300, intraocular pressure was 15 mmHg, anterior segment and vitreous cavity were clear without evidence of TAAC granules, and retina was attached. FA and ICGA showed a complete occlusion of the RAP and absence of leakage or ischemia and OCT demonstrated decreased macular thickness with resolution of both intraretinal edema and pigment epithelium detachment, and the restoration of the normal macular profile. At the end of follow-up, the authors did not observe any ocular or systemic complication.
Conclusions:
Surgical approach to RAP stage 3 with intravitreal injection of 4 mg of TAAC was safe and anatomically effective.
Insights
This study presents a novel surgical approach for retinal angiomatous proliferation (RAP) in age-related macular degeneration (ARMD). The combined surgical treatment, including vitrectomy and intravitreal triamcinolone acetonide, proved safe and effective in resolving RAP lesions.
Area of Science:
- Ophthalmology
- Retinal Diseases
- Surgical Innovation
Background:
- Neovascular age-related macular degeneration (ARMD) with retinal angiomatous proliferation (RAP) presents a significant challenge due to its poor natural history and lack of established treatments.
- This study investigates a combined surgical approach for Stage 3 RAP, aiming to improve outcomes.
Observation:
- A 76-year-old female with Stage 3 RAP underwent pars plana vitrectomy, endodiathermy of feeder vessels, and intravitreal triamcinolone acetonide (TAAC).
- Post-operative assessments included best-corrected visual acuity (BCVA), intraocular pressure, and multimodal imaging (FA, ICGA, OCT) at multiple time points.
Findings:
- Six months post-surgery, BCVA remained stable at 20/300 with normal intraocular pressure.
- Multimodal imaging confirmed complete occlusion of RAP lesions, absence of leakage, and resolution of macular edema and pigment epithelium detachment.
- No ocular or systemic complications were observed during the follow-up period.
Implications:
- The described combined surgical technique is a safe and anatomically effective treatment option for Stage 3 RAP.
- This approach offers a potential new therapeutic strategy for patients with this challenging form of ARMD.
