Intravitreal Ranibizumab, Intravitreal Ranibizumab With Pdt, and Intravitreal Triamcinolone With PDT for the Treatment of Retinal Angiomatous Proliferation

In Brief Purpose: To compare 1) intravitreal ranibizumab, 2) intravitreal ranibizumab plus photodynamic therapy (PDT), and 3) intravitreal triamcinolone plus PDT in retinal angiomatous proliferation. Methods: In this prospective study, 37 eyes of 37 patients with retinal angiomatous proliferation were randomly assigned in 1 of the 3 groups. The patients in Group 1 (n = 13) received 3 monthly injections of 0.5 mg of ranibizumab. The patients in Group 2 (n = 13) received one session of PDT and 3 monthly intravitreal injections of 0.5 mg ranibizumab and the patients in Group 3 (n = 11) received one session of PDT and 1 injection of 4 mg triamcinolone. Retreatment, with the same therapeutic scheme in each group, was considered in case of persistence or recurrence of subretinal fluid or intraretinal fluid. Results: All the patients completed at least 6 months of follow-up. A total of 61.53% patients in Group 1, 76.92% in Group 2, and all in Group 3 had the same or better visual acuity at the end of the follow-up (P = 0.0232). The mean central retinal thickness reduction in Group 1 was 32.23 μm (P = 0.548), in Group 2 20.31 μm (P = 0.042), and in Group 3 73.92 μm (P < 0.0001). Also, the patients in Group 3 received on average the lowest number of injections (P < 0.0001). Conclusion: All groups resulted in stabilization of the disease, while a significant trend towards better visual acuity and anatomic restoration of the affected area was observed in the intravitreal triamcinolone & PDT group. In this prospective study, ranibizumab alone and with photodynamic therapy and triamcinolone plus photodynamic therapy resulted in stabilization of retinal angiomatous proliferation lesions. A trend towards better visual acuity and anatomic restoration of the affected area was observed in the triamcinolone plus photodynamic therapy group.