Efficacy of intravitreal and periocular triamcinolone associated with photodynamic therapy for treatment of retinal angiomatous proliferation

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Aims:To compare the relative efficacy of photodynamic therapy (PDT), PDT associated with intravitreal triamcinolone (PDT–IT) and PDT associated with periocular triamcinolone (PDT–PT) for treatment of retinal angiomatous proliferation (RAP) stage III.Methods:Retrospective, interventional, non-randomised multicentric study. The files, optical coherence tomography scans, indocyanine green and fluorescein angiograms of patients with RAP stage III who had been referred to a regional centre for PDT were retrospectively examined. Final visual acuity and chorioretinal atrophy were considered to be the main outcome indicators. The need to re-treat and recurrences were also considered.Results:Forty-two eyes were treated by PDT as monotherapy, 18 eyes by PDT–PT, and 19 eyes by PDT–IT. The mean (SD) age in each group was 79.1 (5.2), 77.0 (5.9) and 80.2 (5.1) years, respectively. The mean (SD) initial best corrected visual acuity (BCVA) was 0.17 (0.19), 0.21 (0.20) and 0.20 (0.18), respectively. Mean BCVA was 0.14 (0.19), 0.17 (0.15) and 0.17 (0.23), respectively, at 6 months (p = 0.27, 0.33 and 0.21, respectively) and 0.12 (0.18), 0.10 (0.10) and 0.17 (0.26), respectively, at 12 months (p = 0.12, 0.05 and 0.60, respectively, comparing vision at 6 months and 12 months with baseline; Student t test for paired data). Retinal pigment epithelium rips appeared in three eyes in group 1, in one eye in group 2, and in two eyes in group 3.Conclusion:Combined PDT–IT may offer better results than PDT monotherapy or PDT–PT in patients with RAP stage III.

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