Skip to main content
PMC home page
Current Therapeutic Research, Clinical and Experimental logoLink to Current Therapeutic Research, Clinical and Experimental
. 2009 Jun;70(3):240–251. doi: 10.1016/j.curtheres.2009.05.001

Treatment of recurrent retinal angiomatous proliferation with intravitreal triamcinolone acetonide followed by photodynamic therapy with verteporfin: A retrospective case series

Nicola Cardascia 1,*, Claudio Furino 1, Andrea Ferrara 1, Francesco Boscia 1, Giovanni Alessio 1
PMCID: PMC3967339  PMID: 24683234

Abstract

Objective: The aim of this study was to report the effect on tolerability of combined treatment with intravitreal triamcinolone acetonide (IVT) and photodynamic therapy (PDT) with verteporfin in patients with stage II retinal angiomatous proliferation (RAP) who had been treated previously with PDT and presented with recurrent RAP (R-RAP).

Methods: This was a retrospective case series of patients with R-RAP after PDT (1–5 treatments) treated once with IVT followed 1 month later by PDT. A visual acuity test, fluorescein and indocyanine green angiography, and optical coherence tomography were performed at baseline and at 1, 3, and 6 months.

Results: Five patients (4 men, 1 woman; mean [SD] age, 76.8 [3.9] years) with 6 eyes diagnosed with stage II R-RAP who had previously been treated with PDT and who received an IVT injection and PDT within 1 month were included in the study. Best corrected visual acuity (BCVA) remained stable after IVT in 5 eyes (83%) and deteriorated in 1 eye (17%). After PDT, BCVA remained stable in 2 eyes (33%) and deteriorated in 4 eyes (67%). IVT treatment combined with PDT also reduced fluorescein leakage. Median lesion size increased 24% before PDT and 61% at 6 months after PDT. One eye had intraocular hypertension at 3 months, and 1 eye developed a pigment epithelial tear after PDT.

Conclusion: The results were limited by the number of eyes and relatively short follow-up, but in this study, PDT after IVT did not appear to be as effective or well tolerated in 5 patients who had already been treated with PDT and presented with R-RAP.

Key words: intravitreal triamcinolone acetonide, photodynamic therapy, retinal angiomatous proliferation

Full Text

The Full Text of this article is available as a PDF (2.0 MB).

References

  • 1.Bressler NM, Bressler SB, Fine SL. Age-related macular degeneration. Surv Ophthalmol. 1988;32:375–413. doi: 10.1016/0039-6257(88)90052-5. [DOI] [PubMed] [Google Scholar]
  • 2.Mitchell P, Smith W, Attebo K, Wang JJ. Prevalence of age-related maculopathy in Australia. The Blue Mountains Eye Study. Ophthalmology. 1995;102:1450–1460. doi: 10.1016/s0161-6420(95)30846-9. [DOI] [PubMed] [Google Scholar]
  • 3.Vingerling JR, Dielemans I, Hofman A. The prevalence of age-related maculopathy in the Rotterdam Study. Ophthalmology. 1995;102:205–210. doi: 10.1016/s0161-6420(95)31034-2. [DOI] [PubMed] [Google Scholar]
  • 4.Freund KB, Yannuzzi LA, Sorenson JA. Age-related macular degeneration and choroidal neovascularization. Am J Ophthalmol. 1993;115:786–791. doi: 10.1016/s0002-9394(14)73649-9. [DOI] [PubMed] [Google Scholar]
  • 5.Macular Photocoagulation Study Group Subfoveal neovascular lesions in age-related macular degeneration. Guidelines for evaluation and treatment in the Macular Photocoagulation Study. Arch Ophthalmol. 1991;109:1242–1257. [PubMed] [Google Scholar]
  • 6.Axer-Siegel R, Bourla D, Priel E. Angiographic and flow patterns of retinal choroidal anastomoses in age-related macular degeneration with occult choroidal neovascularization. Ophthalmology. 2002;109:1726–1736. doi: 10.1016/s0161-6420(02)01149-1. [DOI] [PubMed] [Google Scholar]
  • 7.Gass JD, Agarwal A, Lavina AM, Tawansy KA. Focal inner retinal hemorrhages in patients with drusen: An early sign of occult choroidal neovascularization and chorioretinal anastomosis. Retina. 2003;23:741–751. doi: 10.1097/00006982-200312000-00001. [DOI] [PubMed] [Google Scholar]
  • 8.Costa RA, Calucci D, Paccola L. Occult chorioretinal anastomosis in age-related macular degeneration: A prospective study by optical coherence tomography. Am J Ophthalmol. 2005;140:107–116. doi: 10.1016/j.ajo.2005.02.042. [DOI] [PubMed] [Google Scholar]
  • 9.Massacesi AL, Sacchi L, Bergamini F, Bottoni F. The prevalence of retinal angiomatous proliferation in age-related macular degeneration with occult choroidal neovascularization. Graefes Arch Clin Exp Ophthalmol. 2008;246:89–92. doi: 10.1007/s00417-007-0638-x. [DOI] [PubMed] [Google Scholar]
  • 10.Schmidt-Erfurth U, Miller JW, Sickenberg M. Photodynamic therapy with verteporfin for choroidal neovascularization caused by age-related macular degeneration: Results of retreatments in a phase 1 and 2 study [published correction appears in Arch Ophthalmol. 2000;115:488] Arch Ophthalmol. 1999;117:1177–1187. doi: 10.1001/archopht.117.9.1177. [DOI] [PubMed] [Google Scholar]
  • 11.Treatment of Age-Related Macular Degeneration with Photodynamic Therapy (TAP) Study Group Photodynamic therapy of subfoveal choroidal neovascularization in age-related macular degeneration with verteporfin: One-year results of 2 randomized clinical trials—TAP report [published correction appears in Arch Ophthalmol. 2000;118:488] Arch Ophthalmol. 1999;117:1329–1345. [PubMed] [Google Scholar]
  • 12.Bressler NM, the Treatment of Age-Related Macular Degeneration with Photodynamic Therapy (TAP) Study Group Photodynamic therapy of subfoveal choroidal neovascularization in age-related macular degeneration with verteporfin: Two-year results of 2 randomized clinical trials—TAP report 2. Arch Ophthalmol. 2001;119:198–207. [PubMed] [Google Scholar]
  • 13.Bressler NM. Verteporfin therapy of subfoveal choroidal neovascularization in age-related macular degeneration: Two–year results of a randomized clinical trial including lesions with occult with no classic choroidal neovascularization—verteporfin in photodynamic therapy report 2. Am J Ophthalmol. 2002;103:168–169. doi: 10.1016/s0002-9394(01)01237-5. [DOI] [PubMed] [Google Scholar]
  • 14.Boscia F, Parodi MB, Furino C. Photodynamic therapy with verteporfin for retinal an-giomatous proliferation. Graefes Arch Clin Exp Ophthalmol. 2006;244:1224–1232. doi: 10.1007/s00417-005-0205-2. [DOI] [PubMed] [Google Scholar]
  • 15.Ciulla TA, Criswell MH, Danis RP, Hill TE. Intravitreal triamcinolone acetonide inhibits cho-roidal neovascularization in a laser-treated rat model. Arch Ophthalmol. 2001;199:399–404. doi: 10.1001/archopht.119.3.399. [DOI] [PubMed] [Google Scholar]
  • 16.Danis RP, Bingaman DP, Yang Y, Ladd B. Inhibition of preretinal and optic nerve head neovascu-larization in pigs by intravitreal triamcinolone acetonide. Ophthalmology. 1996;103:2099–2104. doi: 10.1016/s0161-6420(96)30383-7. [DOI] [PubMed] [Google Scholar]
  • 17.Tano Y, Chandler D, Machemer R. Treatment of intraocular proliferation with intravitreal injection of triamcinolone acetonide. Am J Ophthalmol. 1980;90:810–816. doi: 10.1016/s0002-9394(14)75196-7. [DOI] [PubMed] [Google Scholar]
  • 18.Antoszyk AN, Gottlieb JL, Machemer R, Hatshell DL. The effects of intravitreal triamcinolone acetonide on experimental pre-retinal neovascularization. Graefes Arch Clin Exp Ophthalmol. 1993;231:34–40. doi: 10.1007/BF01681698. [DOI] [PubMed] [Google Scholar]
  • 19.Rechtman E, Danis RP, Pratt LM, Harris A. Intravitreal triamcinolone with photodynamic therapy for subfoveal choroidal neovascularization in age related macular degeneration. Br J Ophthalmol. 2004;88:344–347. doi: 10.1136/bjo.2003.027177. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 20.Chan WM, Lai TY, Wong AL. Combined photodynamic therapy and intravitreal triam-cinolone injection for the treatment of subfoveal choroidal neovascularisation in age related macular degeneration: A comparative study. Br J Ophthalmol. 2006;90:337–341. doi: 10.1136/bjo.2005.081299. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 21.Augustin AJ, Schmidt-Erfurth U. Verteporfin and intravitreal triamcinolone acetonide combination therapy for occult choroidal neovascularization in age-related macular degeneration. Am J Ophthalmol. 2006;141:638–645. doi: 10.1016/j.ajo.2005.11.058. [DOI] [PubMed] [Google Scholar]
  • 22.Bottoni F, Romano M, Massacesi A, Bergamini F. Remodeling of the vascular channels in retinal angiomatous proliferations treated with intravitreal triamcinolone acetonide and photodynamic therapy. Graefes Arch Clin Exp Ophthalmol. 2006;244:1528–1533. doi: 10.1007/s00417-006-0311-9. [DOI] [PubMed] [Google Scholar]
  • 23.Nicolo M, Ghiglione D, Lai S, Calabria G. Retinal angiomatous proliferation treated by intravitreal triamcinolone and photodynamic therapy with verteporfin. Graefes Arch Clin Exp Ophthalmol. 2006;244:1336–1338. doi: 10.1007/s00417-006-0306-6. [DOI] [PubMed] [Google Scholar]
  • 24.Freund KB, Klais CM, Eandi CM. Sequenced combined intravitreal triamcinolone and indocyanine green angiography-guided photodynamic therapy for retinal angiomatous proliferation. Arch Ophthalmol. 2006;124:487–492. doi: 10.1001/archopht.124.4.487. [DOI] [PubMed] [Google Scholar]
  • 25.Sakimoto S, Gomi F, Sakaguchi H, Tano Y. Recurrent retinal angiomatous proliferation after surgical ablation. Am J Ophthalmol. 2005;139:917–918. doi: 10.1016/j.ajo.2004.10.046. [DOI] [PubMed] [Google Scholar]
  • 26.Shimada H, Mori R, Arai K. Surgical excision of neovascularization in retinal angioma-tous proliferation. Graefes Arch Clin Exp Ophthalmol. 2005;243:519–524. doi: 10.1007/s00417-004-1073-x. [DOI] [PubMed] [Google Scholar]
  • 27.Ahlers C, Michels S, Elsner H. Topographic angiography and optical coherence tomography: A correlation of imaging characteristics. Eur J Ophthalmol. 2005;15:774–781. doi: 10.1177/112067210501500619. [DOI] [PubMed] [Google Scholar]
  • 28.Borrillo JL, Sivalingam A, Martidis A, Federman JL. Surgical ablation of retinal angiomatous proliferation. Arch Ophthalmol. 2003;121:558–561. doi: 10.1001/archopht.121.4.558. [DOI] [PubMed] [Google Scholar]
  • 29.Silva RM, Faria de Abreu JR, Travassos A, Cunha-Vaz JG. Stabilization of visual acuity with photodynamic therapy in eyes with chorioretinal anastomoses. Graefes Arch Clin Exp Ophthalmol. 2004;242:368–376. doi: 10.1007/s00417-003-0844-0. [DOI] [PubMed] [Google Scholar]
  • 30.Panagiotidis D, Karagiannis DA, Baltatzis S. Photodynamic therapy in retinal angiomatous proliferation stage I. Eur J Ophthalmol. 2006;16:326–329. doi: 10.1177/112067210601600221. [DOI] [PubMed] [Google Scholar]
  • 31.Challa JK, Gillies MC, Penfold PL. Exudative macular degeneration and intravitreal triamcinolone: 18 Month follow up. Aust N Z J Ophthalmol. 1998;26:277–281. doi: 10.1111/j.1442-9071.1998.tb01330.x. [DOI] [PubMed] [Google Scholar]
  • 32.Jonas JB, Akkoyun I, Budde WM. Intravitreal reinjection of triamcinolone for exudative age-related macular degeneration. Arch Ophthalmol. 2004;122:218–222. doi: 10.1001/archopht.122.2.218. [DOI] [PubMed] [Google Scholar]
  • 33.Bottoni F, Romano M, Massacesi A, Bergamini F. Remodeling of the vascular channels in retinal angiomatous proliferations treated with intravitreal triamcinolone acetonide and photodynamic therapy. Graefes Arch Clin Exp Ophthalmol. 2006;244:1528–1533. doi: 10.1007/s00417-006-0311-9. [DOI] [PubMed] [Google Scholar]
  • 34.Freund KB, Klais CM, Eandi CM. Sequenced combined intravitreal triamcinolone and indocyanine green angiography-guided photodynamic therapy for retinal angiomatous proliferation. Arch Ophthalmol. 2006;124:487–492. doi: 10.1001/archopht.124.4.487. [DOI] [PubMed] [Google Scholar]
  • 35.Nicolò M, Ghiglione D, Lai S. Occult with no classic choroidal neovascularization secondary to age-related macular degeneration treated by intravitreal triamcinolone and photodynamic therapy with verteporfin. Retina. 2006;26:58–64. doi: 10.1097/00006982-200601000-00010. [DOI] [PubMed] [Google Scholar]
  • 36.Verteporfin in Photodynamic Therapy Study Group Verteporfin therapy of subfoveal choroidal neovascularization in age-related macular degeneration: Two-year results of a randomized clinical trial including lesions with occult with no classic choroidal neovascularization—verteporin in photodynamic therapy report 2. Am J Ophthalmol. 2001;131:541–560. doi: 10.1016/s0002-9394(01)00967-9. [DOI] [PubMed] [Google Scholar]
  • 37.Halaby IA, Lyden SP, Davies MG. Glucocorticoid-regulated VEGF expression in ischemic skeletal muscle. Mol Ther. 2002;5:300–306. doi: 10.1006/mthe.2002.0539. [DOI] [PubMed] [Google Scholar]
  • 38.Perretti M, Ahluwalia A. The microcirculation and inflammation: Site of action for glucocorticoids. Microcirculation. 2000;7:147–161. [PubMed] [Google Scholar]
  • 39.Nauck M, Roth M, Tamm M. Induction of vascular endothelial growth factor by platelet-activating factor and platelet-derived growth factor is downregulated by corticosteroids. Am J Respir Cell Mol Biol. 1997;16:398–406. doi: 10.1165/ajrcmb.16.4.9115750. [DOI] [PubMed] [Google Scholar]
  • 40.Cantrill HL, Ramsay RC, Knobloch WH. Rips in the pigment epithelium. Arch Ophthalmol. 1983;101:1074–1079. doi: 10.1001/archopht.1983.01040020076013. [DOI] [PubMed] [Google Scholar]
  • 41.Axer-Siegel R, Lichter H, Rosenblatt I. Simultaneous indocyanine green and fluorescein angiography in retinal pigment epithelium tear using the confocal scanning laser ophthalmoscope. Am J Ophthalmol. 1999;128:331–339. doi: 10.1016/s0002-9394(99)00176-2. [DOI] [PubMed] [Google Scholar]
  • 42.Retinal pigment epithelial detachments in the elderly: A controlled trial with argon laser photocoagulation. Br J Ophthalmol. 1982;66:1–16. doi: 10.1136/bjo.66.1.1. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 43.McCuen BW, II, Bessler M, Tano Y. The lack of toxicity of intravitreally administered triamcinolone acetonide. Am J Ophthamol. 1981;91:785–788. doi: 10.1016/0002-9394(81)90013-1. [DOI] [PubMed] [Google Scholar]
  • 44.Krebs I, Krepler K, Stolba U. Retinal angiomatous proliferation: Combined therapy of intravitreal triamcinolone acetonide and PDT versus PDT alone. Graefes Arch Clin Exp Ophthalmol. 2008;246:237–243. doi: 10.1007/s00417-007-0651-0. [DOI] [PubMed] [Google Scholar]
  • 45.Joeres S, Heussen FM, Treziak T. Bevacizumab (Avastin) treatment in patients with retinal angiomatous proliferation. Graefes Arch Clin Exp Ophthalmol. 2007;245:1597–1602. doi: 10.1007/s00417-007-0580-y. [DOI] [PubMed] [Google Scholar]

Articles from Current Therapeutic Research, Clinical and Experimental are provided here courtesy of Elsevier

RESOURCES