Periocular sub-tenon triamcinolone acetonide injections for the treatment of retinal angiomatous proliferation (RAP) and occult choroidal neovascularisation

Intravitreal triamcinolone injections are used for the treatment of occult choroidal neovascularisations (CNV) combined with photodynamic therapy (PDT). However, this therapy is not without considerable risks. The periocular mode of application seems to be a logical alternative. A retrospective case series of 39 eyes with occult CNV either with retinal angiomatous proliferations (RAP) (group A) or with occult choroidal neovascularisation (CNV) (group B), treated with periocular triamcinolone was reviewed. Data regarding efficacy and side effects were extracted. After a mean follow-up of 10 - 11 months 84 % in group A lost < 3 lines of visual acuity (VA). 26 % of them gained > or = 1 line of VA. 16 % lost > or = 3 lines of VA. In group B (19 eyes) VA was stable in 100 %, whereas 20 % gained > or = 1 line. Both groups showed similar results for magnification requirement (MR). A rise in intraocular pressure was found in 15 %. In patients with RAP or occult CNV sub-tenon injections seem to delay moderate to severe visual loss. Whether larger randomised controlled studies regarding this treatment are still relevant in the era of anti-VEGF treatments remains to be seen.