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The role of dynamic indocyanine green angiography in the diagnosis and treatment of retinal angiomatous proliferation

¹ Duke Center for Macular Diseases and Albert Eye Research Institute, Duke University Eye Center, Durham, NC, USA
² The Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami School of Medicine, Miami, FL, USA
³ Medical College of Georgia, Department of Ophthalmology, Augusta, GA, USA

Correspondence to:
S W Cousins, Duke Center for Macular Diseases, Duke University Eye Center, Box 3802 Erwin Road, Durham, NC 27710, USA; scott.cousins{at}duke.edu

Aims: We compared the effectiveness and durability of indocyanine green angiography (ICG) directed focal thermal laser treatment of the afferent arteriole in the treatment of retinal angiomatous proliferation (RAP).

Methods: Sixteen consecutive patients presenting with stage I or II RAP lesions underwent optical coherence tomography, fluorescein angiography and dynamic ICG examination and were evaluated for response to treatment. Two groups were evaluated: focal laser as initial treatment; and focal laser as salvage treatment after recurrence with photodynamic therapy (PDT) and intravitreal triamcinolone. Five additional eyes with stage III RAP were evaluated separately.

Results: Seven eyes received focal laser as initial treatment, and nine eyes received focal laser as salvage treatment after failure of PDT with triamcinolone. Five of seven eyes in the initial focal laser group demonstrated resolution of oedema. All five of the responders recurred (mean 4.4 months). Salvage therapy with PDT and triamcinolone after focal laser failure transiently closed these recurrences. In contrast, eight of nine eyes receiving thermal ablation of the RAP lesion after recurrence from prior PDT/triamcinolone demonstrated initial improvement of the retinal oedema. Four eyes demonstrated no recurrence within a year. None of the five eyes with stage III RAP improved anatomically or visually.

Conclusion: Focal thermal laser treatment of RAP arteriole can resolve retinal oedema. However, durability was longer in eyes with prior PDT and triamcinolone treatment than those receiving thermal laser as initial therapy. These results suggest that focal laser may be useful in treatment of RAP recurrences and that combination therapy with PDT/triamcinolone plus focal laser is better than focal laser alone.

Ethics approval: This work has been supported in part by an unrestricted research grant from Research to Prevent Blindness.