A review of the literature showed no published cases using a combination of intravitreal triamcinolone acetonide (IVTA) and antivascular endothelial growth factor agents for choroidal neovascularization (CNV) with associated retinal angiomatous proliferation (RAP). 1–5 We present a case of RAP with a pigment epithelial detachment (PED) refractory to multiple treatment modalities, but which responded to the combination of intravitreal triamcinolone (Kenalog, Bristol-Myers-Squibb, Peapack, NJ, USA) and intravitreal bevacizumab (Avastin; Genentech, San Francisco, CA, USA).

An 80-year-old woman with bilateral AMD was referred for treatment of CNV. Her vision was 20/150 right eye (OD) and counting fingers at 5 feet left eye (OS). Clinical examination showed bilateral fibrovascular PEDs with overlying small coin-shaped geographic atrophy both eyes (OU). There was intraretinal haemorrhage and lipid associated with the PEDs. Fluorescein angiography and indocyanine green angiography showed leakage from minimally classic CNV with RAP lesions OU (Figure 1a and b). Optical coherence tomography (OCT) showed a PED, cystoid macular oedema (CME), and subretinal fluid OU (Figure 2).