Submacular translocation surgery Although currently submacular translocation surgery is no longer advocated for ARMD related CNVM, recent studies have examined its use in a cohort of patients with progressive use from non-ARMD submacular diseases including PIC. They primarily examined final visual acuity and found a large percentage of subjects gained >3 lines of visual acuity (38%) and achieved a final visual acuity of ≥ 20/50 (31%) over a mean followup of 28 months 48 . The submacular surgery trial examined a cohort of patients following submacular surgery and recurrent CNV developed in 58 % of patients. One recent publication examined the ultrastructural and pathological features of CNVMs in PIC in a patient with PIC who initially had intravitreal bevacizumab followed by submacular surgery when this failed 50 . This study noted recurred in on eye of a PIC patient with bilateral CNVMs who had submacular surgery in both eyes. This was consistent with the study by Olsen et al in which four out of six eyes developed a recurrence of CNV following surgical excision 10 .
Triamcinolone Acetonide: Triamcinolone acetonide is a synthetic corticosteroid. Corticosteroids are hormones that are produced naturally by the body. This class of compounds contains the most potent anti-inflammatory drugs available to us. They work by inhibiting certain reactions in cells that are responsible for causing allergic responses and inflammation. Triamcinolone acetonide is a potent and long lasting version of a corticosteroid. Unfortunately, prolonged exposure to corticosteroids can cause high intraocular pressure and induce cataract formation.