F. Boscia, C. Furino, N. Cardascia, L. Sborgia, N. Recchimurzo, C. Sborgia

Purpose:

To evaluate functional and anatomic results of surgical ablation and intravitreal triamcinolone acetonide for retinal angiomatous proliferation.

Methods:

A seventy-six year old Caucasian white woman presented to our observation with a best correct visual acuity (BCVA) of 20/600 in the right eye and macula affected by stage 3 RAP as identified by fluorescein angiography (FA), indocyanine green angiography (ICG-A) 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 RAPs 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, ICG-angiography, and OCT to asses outcomes and complications.

Results:

Six months later, BCVA was stable at 20/300, intraocular pressure was 15mmHg, anterior segment and vitreous cavity were clear without evidence of TAAC granules and retina was attached. Fluorescein and ICG-A showed a complete occlusion of the RAPs, and absence of leakage or ischemia and OCT demonstrated the decreased macular thickness with resolution of both intraretinal edema and PED, and the restoration of the normal macular profile. At the end of follow up, we did not observe any ocular or systemic complication.

Conclusion:

Surgical approach to RAP stage 3 with intravitreal injection of 4 mg of TAAC was safe and anatomically effective.

Take-home message:

Surgical approach to RAP stage 3 with intravitreal TAAC was safe and anatomically effective.