J Korean Ophthalmol Soc.  2008 Mar;49(3):442-449. 10.3341/jkos.2008.49.3.442.

Treatments of Stage 1 Retinal Angiomatous Proliferation

• Lee PY
• Lee WK

• KMID: 2211317
• DOI: http://doi.org/10.3341/jkos.2008.49.3.442

Abstract

PURPOSE: To evaluate the results of single or combined treatment methods administered to patients with stage 1 retinal angiomatous proliferation (RAP).
METHODS
A retrospective clinical study was performed in 9 eyes of 8 patients with stage I RAP. According to fundus angiography findings taken regularly after treatment, the results were categorized as closure of stage 1, recurrence of stage 1, or progress to stage 2.
RESULTS
The mean follow-up period was 25 (14~40) months. In two eyes treated with laser photocoagulation only, the lesions progressed to stage 2. In two eyes treated with laser photocoagulation and intravitreal triamcinolone injection, the lesions also progressed to stage 2. In four eyes treated with photodynamic therapy and intravitreal triamcinolone injection, stage 1 lesions recurred in 3 eyes, and the lesion progressed to stage 2 in one eye. In one eye treated with photodynamic therapy, intravitreal triamcinolone injection, and laser photocoagulation, the stage 1 lesion recurred. Final visual acuity was stable in the case of stage 1 recurrence but was lower than the pretreatment level when the lesion progressed to stage 2.
CONCLUSIONS
With either single or combined therapy, temporary closure of the stage 1 RAP lesion was possible, but complete closure could not be achieved for a long period because the lesion either recurred or progressed.

Keyword

Intravitreal triamcinolone injection; Laser photocoagulation; Photodynamic therapy; Retinal angiomatous proliferation; Stage 1

MeSH Terms

Angiography
Eye
Follow-Up Studies
Humans
Light Coagulation
Photochemotherapy
Recurrence
Retinaldehyde
Retrospective Studies
Triamcinolone
Visual Acuity
Retinaldehyde
Triamcinolone

Figure

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  Figure 1. Case 4: A 71-year-old female patient with stage 1 retinal angiomatous proliferation (RAP) in the right eye. Visual acuity was 0.63. (A) Baseline fundus photograph showed multiple soft drusens and extrafoveal superficial intraretinal hemorrhage (arrow). (B) Baseline late phase indocyanine green angiogram (ICGA) showed a hyperfluorescent lesion (arrow) at the site of retinal hemorrhage corresponding to stage 1 RAP. After direct laser photocoagulation and intravitreal triamcinolone injection, there was no exudation. (C) One year after treatment, fundus photograph showed newly developed superficial intraretinal hemorrhage (arrow) with old laser photocoagulation scar (arrowheads) inferiorly. (D) Late phase ICGA also showed new lesion (arrow) representing stage 1 RAP recurrence. The second laser photocoagulation at the new lesion was performed. (E) After second treatment, RAP lesion disappeared on ICGA for one year. (F) One year after second treatment, fundus photograph showed large retinal pigment epithelial tear (arrowheads) at the superotemporal area of the macula. Visual acuity was 0.32.

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  Figure 2. Case 7: A 77-year-old female patient with stage 1 retinal angiomatous proliferation (RAP) in the right eye. Visual acuity was 0.2. (A) Baseline mid-phase indocyanine green angiogram (ICGA) showed a RAP lesion (arrow) with retinal-retinal anastomosis (arrowheads) corresponding to stage 1 RAP. (B) After one session of photodynamic therapy (PDT) and intravitreal triamcinolone injection (IVTA), late phase ICGA showed no leakage. (C) Five months after first treatment, late phase ICGA showed recurred RAP lesion (arrow) at previous lesion. (D) After second session of PDT and IVTA, recurred lesion disappeared. (E) Six months after second treatment, late phase ICGA showed recurred lesion (arrow) at previous lesion again. (F) After third session of PDT and IVTA, the recurred lesion disappeared. Visual acuity was 0.25.

Reference

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