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Fallico M, Macchi I, Maugeri A, Favara G, Barchitta M, Magnano San Lio R, Agodi A, Russo A, Longo A, Avitabile T, Castellino N, Reibaldi M, Pignatelli F, Vadalà M, Patanè C, Nebbioso M, Bonfiglio V. Anti-vascular endothelial growth factor monotherapy or combined with verteporfin photodynamic therapy for retinal angiomatous proliferation: a systematic review with meta-analysis. Front Pharmacol 2023; 14:1141077. [PMID: 37377929 PMCID: PMC10291099 DOI: 10.3389/fphar.2023.1141077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 05/19/2023] [Indexed: 06/29/2023] Open
Abstract
Purpose: To assess functional and anatomical outcomes of intravitreal anti-Vascular Endothelial Growth Factor (anti-VEGF) monotherapy versus combined with verteporfin Photodynamic Therapy (PDT) for Retinal Angiomatous Proliferation (RAP). Methods: Studies reporting outcomes of intravitreal anti-VEGF monotherapy and/or in combination with verteporfin PDT in RAP eyes with a follow-up ≥ 12 months were searched. The primary outcome was the mean change in best corrected visual acuity (BCVA) at 12 months. Mean change in central macular thickness (CMT) and mean number of injections were considered as secondary outcomes. The mean difference (MD) between pre- and post-treatment values was calculated along with 95% Confidence Interval (95% CI). Meta-regressions were performed to assess the influence of anti-VEGF number of injections on BCVA and CMT outcomes. Results: Thirty-four studies were included. A mean gain of 5.16 letters (95% CI = 3.30-7.01) and 10.38 letters (95% CI = 8.02-12.75) was shown in the anti-VEGF group and combined group, respectively (anti-VEGF group vs. combined group, p < 0.01). A mean CMT reduction of 132.45 µm (95% CI = from -154.99 to -109.90) and 213.93 µm (95% CI = from -280.04 to -147.83) was shown in the anti-VEGF group and combined group, respectively (anti-VEGF group vs. combined group, p < 0.02). A mean of 4.9 injections (95% CI = 4.2-5.6) and 2.8 injections (95% CI = 1.3-4.4) were administered over a 12-month period in the anti-VEGF group and combined group, respectively. Meta-regression analyses showed no influence of injection number on visual and CMT outcomes. High heterogeneity was found across studies for both functional and anatomical outcomes. Conclusion: A combined approach with anti-VEGF and PDT could provide better functional and anatomical outcomes in RAP eyes compared with anti-VEGF monotherapy.
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Affiliation(s)
- Matteo Fallico
- Department of Ophthalmology, University of Catania, Catania, Italy
| | - Iacopo Macchi
- Newcastle Eye Unit, Royal Victoria Infirmary, Newcastle Upon Tyne, United Kingdom
| | - Andrea Maugeri
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, University of Catania, Catania, Italy
| | - Giuliana Favara
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, University of Catania, Catania, Italy
| | - Martina Barchitta
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, University of Catania, Catania, Italy
| | - Roberta Magnano San Lio
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, University of Catania, Catania, Italy
| | - Antonella Agodi
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, University of Catania, Catania, Italy
| | - Andrea Russo
- Department of Ophthalmology, University of Catania, Catania, Italy
| | - Antonio Longo
- Department of Ophthalmology, University of Catania, Catania, Italy
| | | | | | - Michele Reibaldi
- Department of Surgical Sciences, Eye Clinic Section, University of Turin, Turin, Italy
| | | | - Maria Vadalà
- Department of Experimental Biomedicine and Clinical Neuroscience, Ophthalmology Section, University of Palermo, Palermo, Italy
| | - Clara Patanè
- Department of Experimental Biomedicine and Clinical Neuroscience, Ophthalmology Section, University of Palermo, Palermo, Italy
| | - Marcella Nebbioso
- Department of Sense Organs, Faculty of Medicine and Dentistry, Sapienza University of Rome, Rome, Italy
| | - Vincenza Bonfiglio
- Department of Experimental Biomedicine and Clinical Neuroscience, Ophthalmology Section, University of Palermo, Palermo, Italy
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Maruyama-Inoue M, Sato S, Yamane S, Kadonosono K. Predictive Factors And Long-Term Visual Outcomes After Anti-Vascular Endothelial Growth Factor Treatment Of Retinal Angiomatous Proliferation. Clin Ophthalmol 2019; 13:1981-1989. [PMID: 31631966 PMCID: PMC6790115 DOI: 10.2147/opth.s224319] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 09/10/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose To report the results of 9-year follow-up examinations and predictive factors for visual acuity outcome after intravitreal injection of anti-vascular endothelial growth factor (VEGF) agents to treat retinal angiomatous proliferation (RAP). Methods We conducted a retrospective observational study of 85 treatment-naïve eyes in 61 patients (21 men, 40 women; age range, 70-95 years; mean age, 84.0 years) treated with intravitreal injections of anti-VEGF agents. All patients received three consecutive monthly injections as an induction treatment. During the maintenance phase, the patients received intravitreal injections as needed or fixed dosing. The primary outcome measures were best-corrected visual acuity (BCVA) during the follow-up period. Furthermore, we investigated potential predictive factors of improvement in visual acuity. The proportion of patients who developed specific complications were also analyzed. Results The mean BCVA gradually decreased from 0.58 at baseline to 0.70 at 36 months (P = 0.146), 0.82 at 48 months (P = 0.004), and 0.92 at 108 months (P = 0.021). Improvement in visual acuity at the final visits was associated with baseline visual acuity and central foveal thickness. Massive subretinal hemorrhage, fibrotic scars, and macular atrophy developed in 4 (4.7%), 9 (10.6%), and 50 (56.8%) eyes, respectively, at the final visits, and were all significantly associated with final visual acuity (P = 0.013, P < 0.001, and P = 0.001, respectively). Conclusion Long-term stabilization of vision in patients with RAP, regardless of treatment modality, was difficult to achieve by using intravitreal injections of anti-VEGF agents. Earlier detection and treatment are important to maintain visual acuity in patients with RAP.
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Affiliation(s)
- Maiko Maruyama-Inoue
- Department of Ophthalmology, Yokohama City University Medical Center, Yokohama, Japan
| | - Shimpei Sato
- Department of Ophthalmology, Yokohama City University Medical Center, Yokohama, Japan
| | - Shin Yamane
- Department of Ophthalmology, Yokohama City University Medical Center, Yokohama, Japan
| | - Kazuaki Kadonosono
- Department of Ophthalmology, Yokohama City University Medical Center, Yokohama, Japan
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Browning A, O’Brien J, Vieira R, Gupta R, Nenova K. Intravitreal Aflibercept for Retinal Angiomatous Proliferation: Results of a Prospective Case Series at 96 Weeks. Ophthalmologica 2019; 242:239-246. [DOI: 10.1159/000500203] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 04/05/2019] [Indexed: 11/19/2022]
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Kim JH, Chang YS, Kim JW, Kim CG, Lee DW. Early Recurrent Hemorrhage in Submacular Hemorrhage Secondary to Type 3 Neovascularization or Retinal Angiomatous Proliferation: Incidence and Influence on Visual Prognosis. Semin Ophthalmol 2018; 33:820-828. [DOI: 10.1080/08820538.2018.1511814] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Jae Hui Kim
- Department of Ophthalmology, Kim’s Eye Hospital, Konyang University College of Medicine, Seoul, South Korea
| | - Young Suk Chang
- Department of Ophthalmology, Konyang University College of Medicine, Daejeon, South Korea
| | - Jong Woo Kim
- Department of Ophthalmology, Kim’s Eye Hospital, Konyang University College of Medicine, Seoul, South Korea
| | - Chul Gu Kim
- Department of Ophthalmology, Kim’s Eye Hospital, Konyang University College of Medicine, Seoul, South Korea
| | - Dong Won Lee
- Department of Ophthalmology, Kim’s Eye Hospital, Konyang University College of Medicine, Seoul, South Korea
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Mantel I, Ambresin A, Zografos L. Retinal Angiomatous Proliferation Treated with a Combination of Intravitreal Triamcinolone Acetonide and Photodynamic Therapy with Verteporfin. Eur J Ophthalmol 2018; 16:705-10. [PMID: 17061221 DOI: 10.1177/112067210601600507] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose Retinal angiomatous proliferation (RAP) is a particularly aggressive form of exudative age-related macular degeneration. Response to laser photocoagulation or to photodynamic therapy (PDT) alone is often disappointing. The purpose of this study was to determine whether intravitreal triamcinolone acetonide (TA) injections followed by PDT in eyes with early stage RAP may be effective. Methods Prospective uncontrolled study, enrolling 11 patients (11 eyes) with stage 2 RAP, treated with intravitreal TA injection followed by PDT. Patients with large pigment epithelium detachment, RAP stage 3, or pre-existing glaucoma and known steroid responders were excluded. All patients underwent a complete ophthalmic examination including fluorescein and indocyanine green (ICG) angiography and optical coherence tomography (OCT-3) at baseline and at 1, 3, 6, and 12 months. Informed consent was obtained from all patients. Results Mean follow-up was 14.9 months (range 6–21 months). Mean age was 82 years. In four patients a small pigment epithelium detachment was found on tomography. Initial visual acuity (VA) ranged from 0.1 to 0.6 on the Snellen scale. After calculating the logarithmic values the authors found an initial mean VA of logMAR 0.61, which improved by 1.5, 0.9, and 0.9 log lines after 3, 6, and 12 months, respectively. Although the VA gain from baseline tended to decrease with time, only 2 patients (18%) had an actual loss of acuity (≥3 lines). Retreatment was required in 5 eyes. Conclusions In this prospective pilot study examining the use of intravitreal TA followed by PDT with verteporfin in eyes with stage 2 RAP, without a large pigment epithelium detachment, the authors found a potential benefit in terms of stabilization or even improvement of vision.
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Affiliation(s)
- I Mantel
- University Eye Clinic, Hôpital Jules Gonin, Lausanne, Switzerland.
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Tsai AS, Cheung N, Gan AT, Jaffe GJ, Sivaprasad S, Wong TY, Cheung CMG. Retinal angiomatous proliferation. Surv Ophthalmol 2017; 62:462-492. [DOI: 10.1016/j.survophthal.2017.01.008] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 01/24/2017] [Accepted: 01/27/2017] [Indexed: 01/06/2023]
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Chou HD, Wu WC, Wang NK, Chuang LH, Chen KJ, Lai CC. Short-term efficacy of intravitreal Aflibercept injections for retinal angiomatous proliferation. BMC Ophthalmol 2017; 17:104. [PMID: 28655307 PMCID: PMC5488380 DOI: 10.1186/s12886-017-0497-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 06/16/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To evaluate the short-term efficacy of intravitreal injections of aflibercept (IVA) to treat retinal angiomatous proliferation (RAP) and identify factors related to functional outcomes. METHODS This retrospective case series consisted of 19 eyes in 19 patients with RAP. All 19 eyes received 3 monthly consecutive IVA. The primary outcome measures were best-corrected visual acuity (BCVA) and central retinal thickness (CRT) after the last IVA. RESULTS Of the 19 treated eyes, 8 (42%) were pre-treated with 1 dose of bevacizumab one month prior to the initiation of treatment with aflibercept. BCVA was significantly improved and CRT was significantly reduced after 3 consecutive IVAs (P = 0.014 and P = 0.0002, respectively). Stabilization or improvement in BCVA was observed in 17 eyes (90%) treated with IVA. Eyes with baseline fibrovascular pigment epithelial detachment (PED) showed no significant gain in BCVA, and fibrovascular PED was negatively correlated with final BCVA (Spearman's correlation coefficient = - 0.481, P = 0.037). The mean follow-up was 3.5 ± 0.5 months. CONCLUSIONS In this short-term study, three consecutive IVAs showed efficacy for improving vision and reducing retinal edema in RAP patients. Eyes with fibrovascular PED showed poorer responses, and the presence of fibrovascular PED at baseline was negatively correlated with visual outcomes.
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Affiliation(s)
- Hung-Da Chou
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 333, Taiwan, Republic of China
| | - Wei-Chi Wu
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 333, Taiwan, Republic of China.,School of Medicine, Chang Gung University, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan City, 333, Taiwan, Republic of China
| | - Nan-Kai Wang
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 333, Taiwan, Republic of China.,School of Medicine, Chang Gung University, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan City, 333, Taiwan, Republic of China
| | - Lan-Hsin Chuang
- School of Medicine, Chang Gung University, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan City, 333, Taiwan, Republic of China.,Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, No. 222, Maijin Rd., Anle Dist., Keelung City, 204, Taiwan, Republic of China
| | - Kuan-Jen Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 333, Taiwan, Republic of China.,School of Medicine, Chang Gung University, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan City, 333, Taiwan, Republic of China
| | - Chi-Chun Lai
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 333, Taiwan, Republic of China. .,School of Medicine, Chang Gung University, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan City, 333, Taiwan, Republic of China.
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Parodi MB, Donati S, Semeraro F, Danzi P, Introini U, Viola F, Bottoni F, Pucci V, Musig A, Pece A, Azzolini C. Intravitreal Anti-Vascular Endothelial Growth Factor Drugs for Retinal Angiomatous Proliferation in Real-Life Practice. J Ocul Pharmacol Ther 2017; 33:123-127. [PMID: 28048946 DOI: 10.1089/jop.2016.0091] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To describe the outcomes of intravitreal anti-vascular endothelial growth factor (VEGF) in the treatment of retinal angiomatous proliferation (RAP) in real-life practice in 7 Italian centers under the Progetto Luce initiative. METHODS Clinical data of 95 eyes of 95 patients affected by RAP, regularly followed up and treated with either intravitreal ranibizumab or bevacizumab over 12 months, were examined. After a loading phase of 3 consecutive injections, retreatments were administered following a pro-re-nata regimen on the basis of the persistence or the recurrence of subretinal/intraretinal fluid on optical coherence tomography, or leakage on fluorescein angiography. RESULTS Overall, the mean best corrected visual acuity changed from 0.66 to 0.53 LogMAR (P: 0.0003); 36.8% of eyes gained at least 3 ETDRS lines, whereas 13.7% lost >3 lines at the end of the follow-up. Mean central retinal thickness improved from 384 μm at baseline to 262 μm at the 12-month examination (P < 0.001). A serous pigment epithelium detachment (PED) was identified in 68.4% of eyes at baseline, and it was still detectable in 30.5% at the end of follow-up. The mean number of injections was 4.4 over the follow-up. A significantly greater proportion of eyes showed PED resolution in the subgroup treated with ranibizumab (P < 0.001). CONCLUSIONS Intravitreal anti-VEGF treatment in routine clinical practice allows a significant improvement in visual function in patients affected by RAP. A limited number of anti-VEGF injections are generally required in most cases.
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Affiliation(s)
| | - Simone Donati
- 2 Section of Ophthalmology, Department of Surgical and Morphological Sciences, University of Insubria , Varese-Como, Italy
| | - Francesco Semeraro
- 3 Eye Clinic, Department of Neurological and Vision Sciences, University of Brescia , Brescia, Italy
| | - Paola Danzi
- 3 Eye Clinic, Department of Neurological and Vision Sciences, University of Brescia , Brescia, Italy
| | - Ugo Introini
- 1 Department of Ophthalmology, San Raffaele Hospital, Università Vita e Salute , Milano, Italy
| | - Francesco Viola
- 4 Ophthalmology Clinic, Clinical and Community Sciences, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, University of Milan , Milan, Italy
| | - Ferdinando Bottoni
- 5 Eye Clinic, Department of Clinical Science "Luigi Sacco," Sacco Hospital, University of Milan , Milan, Italy
| | - Vincenzo Pucci
- 6 Department of Ophthalmology, Desenzano del Garda Hospital , Desenzano del Garda, Italy
| | - Andrea Musig
- 6 Department of Ophthalmology, Desenzano del Garda Hospital , Desenzano del Garda, Italy
| | - Alfredo Pece
- 7 Department of Ophthalmology, Melegnano Hospital , Milano, Italy
| | - Claudio Azzolini
- 2 Section of Ophthalmology, Department of Surgical and Morphological Sciences, University of Insubria , Varese-Como, Italy
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Vujosevic S, Martini F, Midena E. Stage 1 Type 3 Neovascularization With Choroidal Dilation Unresponsive to Anti-VEGF Treatment. Ophthalmic Surg Lasers Imaging Retina 2016; 47:956-959. [DOI: 10.3928/23258160-20161004-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 06/13/2016] [Indexed: 11/20/2022]
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Arias L, Gómez-Ulla F, Ruiz-Moreno JM. Ranibizumab in monotherapy and combined with photodynamic therapy for retinal angiomatous proliferation. Clin Ophthalmol 2016; 10:861-9. [PMID: 27274190 PMCID: PMC4876105 DOI: 10.2147/opth.s106092] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To compare the effects of intravitreal ranibizumab in monotherapy (group A) and combined with photodynamic therapy (PDT) with verteporfin (group B) in retinal angiomatous proliferation (RAP) treatment. Methods This was a multicentric, prospective, randomized clinical study conducted with parallel groups. The study eye in both groups received ranibizumab on days 1, 30, and 60 (loading dose); group B received PDT additionally on day 1. Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity (VA) testing and optical coherence tomography were performed monthly, and fluorescein angiography and indocyanine green angiography were performed quarterly. Retreatment criteria were leakage in fluorescein angiography or indocyanine green angiography, mean foveal thickness increase ≥100 µm, or VA decrease ≥5 letters. Results Twenty patients were recruited (ten patients in each group). Six eyes had previous treatment (three eyes in group A and three eyes in group B), so only 14 eyes were naïve. At 12-month follow-up, mean VA improved +1.5 letters in group A and +5.6 letters in group B (analysis of variance test; P>0.05). Two patients (20%) in both groups gained ≥15 letters (chi-square test; P>0.05). Mean changes in greatest linear dimension and in foveal thickness were not statistically significant between groups of treatment (analysis of variance test; P>0.05). Mean retreatments per patient were 1.8 (group A) and 0.9 (group B) (Mann–Whitney U-test; P>0.05). One patient died due to underlying disease not related to study medication. Conclusion Intravitreal ranibizumab administered in monotherapy or combined with PDT was efficacious in terms of VA stabilization in patients with RAP.
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Affiliation(s)
- Luis Arias
- Ophthalmology Department, Bellvitge University Hospital, C/Feixa Llarga, L'Hospitalet de Llobregat, Barcelona, Spain; Spanish Vitreoretinal Society (SERV), C/Xosé Chao Rego, Santiago de Compostela, Spain; RETICS OFTARED, Institute of Health Carlos III, C/Sinesio Delgado, Madrid, Spain
| | - Francisco Gómez-Ulla
- Spanish Vitreoretinal Society (SERV), C/Xosé Chao Rego, Santiago de Compostela, Spain; RETICS OFTARED, Institute of Health Carlos III, C/Sinesio Delgado, Madrid, Spain; Gómez-Ulla Eye Institute, Santiago de Compostela, Spain
| | - José M Ruiz-Moreno
- Spanish Vitreoretinal Society (SERV), C/Xosé Chao Rego, Santiago de Compostela, Spain; RETICS OFTARED, Institute of Health Carlos III, C/Sinesio Delgado, Madrid, Spain; Department of Ophthalmology, Albacete University Hospital, Avenida de Almansa s/n, Albacete, Spain
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SUBFOVEAL CHOROIDAL THICKNESS CHANGES AFTER INTRAVITREAL RANIBIZUMAB AND PHOTODYNAMIC THERAPY FOR RETINAL ANGIOMATOUS PROLIFERATION. Retina 2015; 35:648-54. [DOI: 10.1097/iae.0000000000000486] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Inoue M, Arakawa A, Yamane S, Kadonosono K. Long-term results of intravitreal ranibizumab for the treatment of retinal angiomatous proliferation and utility of an advanced RPE analysis performed using spectral-domain optical coherence tomography. Br J Ophthalmol 2014; 98:956-60. [DOI: 10.1136/bjophthalmol-2013-304251] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Barbazetto IA, Takahashi BS. Verteporfin photodynamic therapy in the age of antiangiogenic therapy. EXPERT REVIEW OF OPHTHALMOLOGY 2014. [DOI: 10.1586/17469899.3.4.365] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Seidel G, Werner C, Weger M, Steinbrugger I, Haas A. Combination treatment of photodynamic therapy with verteporfin and intravitreal ranibizumab in patients with retinal angiomatous proliferation. Acta Ophthalmol 2013; 91:e482-5. [PMID: 23786546 DOI: 10.1111/aos.12111] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To investigate the efficacy and safety of initial photodynamic therapy (PDT) with a ranibizumab loading dose of three monthly intravitreal injections and a subsequent PRN ranibizumab regimen in the treatment of retinal angiomatous proliferation (RAP). METHODS In this 12-month prospective case series, 15 patients underwent PDT followed by 3 intravitreal ranibizumab injections at monthly intervals. At monthly follow-up examinations, further single ranibizumab injections were given in case of any intra- or subretinal fluid on optical coherence tomography (OCT), visual loss ≥5 letters or signs of activity on fluorescein or indocyanine green angiography. RESULTS Best-corrected visual acuity (BCVA) improved from 58.1 ± 13.2 at baseline by 9.2 letters (SD ± 8.5; p = 0.004) at 6 months and by 8.7 letters (SD ± 11.4; p = 0.017) at 12 months. Neither at 6 nor at 12 months, any patient had lost ≥15 letters. The mean number of injections per patient was 4.8 (SD ± 1.4) in the first year of therapy after PDT. The average time to first retreatment was 3.7 months (range 1-7 months). No serious adverse events, such as endophthalmitis or retinal detachment, were noted. CONCLUSION PDT with 3 ranibizumab loading injections and subsequent ranibizumab as needed resulted in a significant gain of 8.7 ± 11.4 letters at month 12. This regimen is safe and efficacious, but even in a population of mostly early stages of RAP, retreatment rates remained high.
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Affiliation(s)
- Gerald Seidel
- Department of Ophthalmology, Medical University of Graz, Austria.
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Parodi MB, Iacono P, Menchini F, Sheth S, Polini G, Pittino R, Bandello F. Intravitreal bevacizumab versus ranibizumab for the treatment of retinal angiomatous proliferation. Acta Ophthalmol 2013; 91:267-73. [PMID: 21951313 DOI: 10.1111/j.1755-3768.2011.02265.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
PURPOSE To evaluate the effects of intravitreal bevacizumab and ranibizumab treatments in retinal angiomatous proliferation (RAP). METHODS Fifty patients affected by RAP were randomly assigned either to intravitreal bevacizumab injection (IVBI) or intravitreal ranibizumab injection (IVRI). After a loading phase including three consecutive monthly injections, the retreatment was administered in cases of persistent RAP. The primary outcome measures were the mean changes in BCVA between the two treatment groups, and the proportion of eyes gaining 1 and 3 lines at the end of the follow-up. Secondary outcomes included central macular thickness (CMT) changes and progression to more advanced stages of RAP. RESULTS Fifty patients affected by stage 1 and 2 RAP were recruited. Twenty-six and 24 patients received IVBI and IVRI, respectively. At the baseline, mean best corrected visual acuity (BCVA) values were 0.59 ± 0.21 (LogMAR ± SD, approximately corresponding to 20/80 Snellen Equivalent-SE) in IVBI group and 0.66 ± 0.33 (approximately 20/90 SE) in IVRI group with no statistical difference. At 12-month examination, both groups showed a statistically significant improvement in the BCVA, with a final mean value of 0.43 ± 0.24 (approximately 20/54 SE) in IVBI group and 0.50 ± 0.32 (approximately 20/63 SE) in the IVRI group. A BCVA gain of 1 and 3 lines was registered in 20 and 8 eyes, respectively, in the IVBI group. Similarly, 17 and 7 eyes showed an improvement of 1 or 3 lines, respectively, in the IVRI group. The CMT reduced significantly from baseline to 12-month examination in both groups. A lower proportion of eyes with complete pigment epithelium detachment resolution was noted in the IVBI group than in the IVRI group (40% versus 90%). CONCLUSIONS Our study shows that both IVBI and IVRI are equally effective in improving the BCVA over a 1-year follow-up in eyes affected by stage 1 and 2 RAP.
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Affiliation(s)
- Maurizio B Parodi
- Department of Ophthalmology, University Vita-Salute, Scientific Institute San Raffaele, Milano, Italy
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Miki A, Honda S, Kojima H, Nishizaki M, Nagai T, Fujihara M, Uenishi M, Kita M, Kurimoto Y, Negi A. Visual outcome of photodynamic therapy for typical neovascular age-related macular degeneration and polypoidal choroidal vasculopathy over 5 years of follow-up. Jpn J Ophthalmol 2013; 57:301-7. [PMID: 23508554 DOI: 10.1007/s10384-013-0237-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Accepted: 01/07/2013] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the long-term effects of photodynamic therapy (PDT) on typical neovascular age-related macular degeneration (tAMD) and polypoidal choroidal vasculopathy (PCV). METHODS This was a multicenter prospective study of 139 eyes from 136 patients (tAMD: 74 eyes; PCV: 65 eyes) who underwent PDT as the initial treatment. The change in best-corrected visual acuity (BCVA), predictive factors for the BCVA at 60 months, frequency of recurrence, and mean recurrence period were analyzed. RESULTS The pre-PDT BCVA and greatest linear dimension (GLD) did not differ between the two groups. The mean BCVA (logMAR) was significantly improved at 6 months post-initial PDT (post-PDT) in the PCV group (-0.11, P = 0.0091). However, at 60 months post-PDT, the mean BCVA was significantly worse than baseline in the tAMD (+0.21, P = 0.0035) and PCV (+0.21, P = 0.0076) groups. Pre-PDT BCVA, age, and GLD were the factors significantly associated with the BCVA at 60 months post-PDT. Although the frequency of recurrence did not significantly differ between the two phenotype groups, the mean recurrence period was significantly longer in the PCV group than in the tAMD group (15.7 vs. 8.6 months, P = 0.0020). CONCLUSIONS PDT may not have benefits for visual acuity in cases of tAMD and PCV over 5 years of follow-up.
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Affiliation(s)
- Akiko Miki
- Department of Surgery, Division of Ophthalmology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
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One-year results of bevacizumab intravitreal and posterior sub-Tenon injection of triamcinolone acetonide with reduced laser fluence photodynamic therapy for retinal angiomatous proliferation. Jpn J Ophthalmol 2012; 56:599-607. [DOI: 10.1007/s10384-012-0183-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Accepted: 07/06/2012] [Indexed: 11/27/2022]
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Rouvas AA, Chatziralli IP, Theodossiadis PG, Moschos MM, Kotsolis AI, Ladas ID. LONG-TERM RESULTS OF INTRAVITREAL RANIBIZUMAB, INTRAVITREAL RANIBIZUMAB WITH PHOTODYNAMIC THERAPY, AND INTRAVITREAL TRIAMCINOLONE WITH PHOTODYNAMIC THERAPY FOR THE TREATMENT OF RETINAL ANGIOMATOUS PROLIFERATION. Retina 2012; 32:1181-9. [DOI: 10.1097/iae.0b013e318235d8ce] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Introini U, Torres Gimeno A, Scotti F, Setaccioli M, Giatsidis S, Bandello F. Vascularized retinal pigment epithelial detachment in age-related macular degeneration: treatment and RPE tear incidence. Graefes Arch Clin Exp Ophthalmol 2012; 250:1283-92. [DOI: 10.1007/s00417-012-1955-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2011] [Revised: 12/14/2011] [Accepted: 01/30/2012] [Indexed: 10/28/2022] Open
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Nakano S, Honda S, Oh H, Kita M, Negi A. Effect of photodynamic therapy (PDT), posterior subtenon injection of triamcinolone acetonide with PDT, and intravitreal injection of ranibizumab with PDT for retinal angiomatous proliferation. Clin Ophthalmol 2012; 6:277-82. [PMID: 22375096 PMCID: PMC3287414 DOI: 10.2147/opth.s29718] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The purpose of this work was to compare the efficacy of photodynamic therapy (PDT) with or without posterior subtenon injections of triamcinolone acetonide (STA) or intravitreal injections of ranibizumab (IVR) for retinal angiomatous proliferation (RAP). METHODS Thirty-seven eyes from 33 consecutive patients with RAP were treated by PDT monotherapy (Group 1), PDT combined with STA (Group 2), or PDT combined with IVR (Group 3). The best-corrected visual acuity, greatest linear dimension, central retinal thickness, and number of treatments were compared among the three groups. RESULTS The change in mean best-corrected visual acuity (logMAR) at month 3, 6, and 12 after the initial treatment was better in Group 2 (-0.13, -0.23, and -0.21, respectively) and Group 3 (-0.018, 0.0028, and -0.0067, respectively) than in Group 1 (0.13, 0.19, and 0.23, respectively); Group 1 versus Group 2 was statistically significant (P = 0.018). The mean central retinal thickness was reduced from baseline in all groups, but the reduction amplitude was significantly greater in Group 2 than in Group 1 and Group 3. The mean number of treatments was significantly lower in Group 2 (1.1 ± 0.4) and Group 3 (1.5 ± 0.5) than in Group 1 (2.9 ± 0.9) in the 12 months after the initial treatment. CONCLUSION Treatment with STA + PDT may be an effective therapy for RAP lesions over 12 months of follow-up.
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Affiliation(s)
- Saya Nakano
- Department of Surgery, Division of Ophthalmology, Kobe University Graduate School of Medicine, Kobe
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Abstract
PURPOSE To describe the occurrence of geographic atrophy in patients with retinal angiomatous proliferation (RAP). METHODS Demographics, visual acuity, color fundus photographs, fluorescein and indocyanine green angiograms, and fundus autofluorescence and near-infrared autofluorescence images were reviewed in 53 patients (66 eyes) with RAP. RESULTS Of 53 treatment-naive eyes, 19 (36%) had atrophy at baseline. Of 66 eyes, 57 (86%) developed de novo atrophy or enlargement of preexisting areas of atrophy during the follow-up (median, 17 months; range, 3-53 months) after treatment. Areas of atrophy were observed at the site of the RAP (58 of 66 eyes, 88%) of a previously existing pigment epithelial detachment (18 of 44 eyes; 41%) and elsewhere (43 of 66 eyes, 65%). At presentation, RAP was found to be frequently associated with increased autofluorescence at the fovea because of cystoid macular edema (36 of 53 eyes, 68%) and reduced autofluorescence because of hard exudation (38 of 53 eyes, 72%) and intraretinal hemorrhages (32 of 53 eyes, 60%). Background reticular (39%) and homogeneous (36%) autofluorescence were most commonly observed. CONCLUSION Geographic atrophy occurs frequently in patients with RAP after treatment. This information, if confirmed in other cohorts, would be valuable for the counseling of patients with this disease and for the understanding of the pathogenesis of this condition and its progression after treatment.
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Lommatzsch A, Heimes B, Gutfleisch M, Spital G, Dietzel M, Pauleikhoff D. [Retinal angiomatous proliferation with associated pigment epithelium detachment: anti-VEGF therapy]. Ophthalmologe 2011; 108:244-51. [PMID: 20571805 DOI: 10.1007/s00347-010-2221-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Vascularized pigment epithelial detachment (PED) in retinal angiomatous proliferation (RAP) represents a special morphological form of exudative age-related macular degeneration (ARMD) in the natural course and in the frequency of complications, such as tears in the pigment epithelium. In this study the results of inhibition of vascular endothelial growth factor (VEGF) for exudative ARMD with associated PED and RAP were examined. MATERIALS AND METHODS Functional and morphological data were retrospectively collected for 61 consecutive eyes with RAP in stages 2 and 3 over an average observation period of 108 weeks. Patients were treated with bevacizumab (n=15), ranibizumab (n=29) and pegabtanib (n=17) according to the recommendations of the German Society of Ophthalmology (DOG) and the German Retina Society (RG). After an initial treatment cycle of 3 injections every 4 weeks (6 weeks for pegabtanib), best corrected visual acuity (BCVA), fluorescence angiography (FAG), indocyanine green angiography (ICG-A) and optical coherence tomography (OCT) were evaluated every 12 weeks. RESULTS The mean visual acuity was 0.8 logMAR before therapy and 0.77 logMAR after therapy so that the average difference to the original acuity was -0.03 logMAR after 12 weeks and 0.00 logMAR after 48 weeks. The central retinal thickness measured by OCT decreased on average by 81.2 µm after the first cycle of injections and by -68.4 µm after 1 year. The maximum depth of PED could be reduced on average by 1 unit and after 1 year by 1.55 units. Better functional and morphological results were obtained by therapy with ranibizumab and avastin compared to pegabtanib (p=0.03). An RIP occurred in 9.8% of the patients (n=6) on average after 16 weeks. CONCLUSIONS The morphological functional results can be improved in the early months using the therapy strategy presently recommended in Germany. However, in later stages there was a significant worsening of the functional results. Modification of the treatment strategy with respect to close surveillance and possibly early stage repeat treatment would seem advisable.
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Affiliation(s)
- A Lommatzsch
- Augenabteilung, St. Franziskus-Hospital, Hohenzollernring 74, 48145, Münster, Deutschland.
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Forte R. 1 - year follow-up after intravitreal bevacizumab alone and in combination with photodynamic therapy for AMD and PCV. Acta Ophthalmol 2011; 89:e373. [PMID: 21040503 DOI: 10.1111/j.1755-3768.2010.01991.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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COMBINATION THERAPY OF RANIBIZUMAB AND PHOTODYNAMIC THERAPY FOR RETINAL ANGIOMATOUS PROLIFERATION WITH SEROUS PIGMENT EPITHELIAL DETACHMENT IN KOREAN PATIENTS. Retina 2011; 31:65-73. [DOI: 10.1097/iae.0b013e3181e586e3] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ranibizumab for retinal angiomatous proliferation in age-related macular degeneration. Eye (Lond) 2010; 24:1193-8. [PMID: 20150927 DOI: 10.1038/eye.2010.9] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
PURPOSE To assess the 1-year functional outcome and to evaluate the morphological changes after intravitreal injections of ranibizumab in eyes affected with retinal angiomatous proliferation (RAP) due to age-related macular degeneration (AMD). METHODS A prospective, non-randomized, interventional study was conducted on 26 consecutive patients with newly diagnosed RAP. All eyes were treatment naive and were randomized to receive intravitreal injections of ranibizumab for a 12-month period. After the first three monthly injections, re-treatment was performed in case of best-corrected visual acuity (BCVA) loss of at least five letters associated with fluid within the macula, central macular thickness (CMT) increase of at least 100 microm, and/or persistence of fluid within the macula as evaluated by optical coherence tomography, new onset macular haemorrhages, persistence of leakage from the lesions on fluorescein angiography. RESULTS All patients completed the 12-month follow-up: 25 of the 29 treated eyes (86.2%) were stabilized, with a loss of less than 15 letters. Nineteen eyes (65.5%) maintained or improved their BCVA, and three eyes (10.3%) gained three lines or more. Overall, mean BCVA remained stable at the 12-month follow-up (-0.07 letters; P>0.05). Mean CMT significantly decreased from 386+/-147 to 216+/-74 microm at the 12-month follow-up. No significant adverse events were observed during the study. The mean number of injections was 5.8+/-1.7 during the follow-up period. CONCLUSION The 1-year follow-up outcomes in our series suggest that ranibizumab is an effective treatment for RAP in AMD, allowing stabilization of BCVA and reduction of CMT.
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Honda S, Kurimoto Y, Kagotani Y, Yamamoto H, Takagi H, Uenishi M. Photodynamic therapy for typical age-related macular degeneration and polypoidal choroidal vasculopathy: A 30-month multicenter study in Hyogo, Japan. Jpn J Ophthalmol 2009; 53:593-597. [PMID: 20020237 DOI: 10.1007/s10384-009-0741-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2009] [Accepted: 06/14/2009] [Indexed: 11/30/2022]
Affiliation(s)
- Shigeru Honda
- Department of Surgery, Division of Ophthalmology, Kobe University Graduate School of Medicine, Kobe, Japan.
- Department of Surgery, Division of Ophthalmology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
| | - Yasuo Kurimoto
- Department of Ophthalmology, Kobe City General Hospital, Kobe, Japan
| | | | - Hiroyuki Yamamoto
- Department of Ophthalmology, Nippon Steel Hirohata Hospital, Himeji, Japan
| | - Hitoshi Takagi
- Department of Ophthalmology, Hyogo Prefectural Amagasaki Hospital, Amagasaki, Japan
| | - Mamoru Uenishi
- Department of Ophthalmology, Mitsubishi Kobe Hospital, Kobe, Japan
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“TREAT AND EXTEND” DOSING OF INTRAVITREAL ANTIVASCULAR ENDOTHELIAL GROWTH FACTOR THERAPY FOR TYPE 3 NEOVASCULARIZATION/RETINAL ANGIOMATOUS PROLIFERATION. Retina 2009; 29:1424-31. [DOI: 10.1097/iae.0b013e3181bfbd46] [Citation(s) in RCA: 147] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Hemeida TS, Keane PA, Dustin L, Sadda SR, Fawzi AA. Long-term visual and anatomical outcomes following anti-VEGF monotherapy for retinal angiomatous proliferation. Br J Ophthalmol 2009; 94:701-5. [PMID: 19854733 DOI: 10.1136/bjo.2009.167627] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
AIM To study the long-term visual and anatomical outcomes of antivascular endothelial growth factor (VEGF) monotherapy for the treatment of patients with retinal angiomatous proliferation (RAP). METHODS Retrospective review of patients who were diagnosed as having AMD and RAP lesions, and who received anti-VEGF injections as the only mode of therapy. RESULTS 20 eyes (15 patients; nine women, six men) with RAP lesions treated by anti-VEGF were encountered. The mean patient age was 85.8 years (SD+/-4.54). Nine eyes were treated with intravitreal ranibizumab alone, eight eyes were treated with bevacizumab alone, and three eyes received both drugs. At 1, 3 and 6 months' follow-up the median VA had improved from baseline (20/72) to 20/52 (range: 20/25 to 20/400), 20/45 (range 20/20 to 20/400), and 20/56 (range 20/20 to 20/400), respectively, (p>0.001, p=0.001 and p=0.05, respectively). At the 24-month follow-up, the improvement in VA, defined as a halving of the visual angle, occurred in 37.5% of the cases. CONCLUSIONS Anti-VEGF monotherapy represents a useful treatment option for RAP, with stable or improved visual acuity in 62.5% of patients at 2 years. 25% of eyes required only a single injection, but in most cases (75%) repeated treatments were required, highlighting the need for long term follow-up. Although, in this small study, the results for visual improvement were not statistically significant beyond 3 months, our findings warrant further large-scale investigation.
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Affiliation(s)
- Tarek S Hemeida
- Doheny Eye Institute, Department of Ophthalmology, Keck School of Medicine of the University of Southern California, Los Angeles, CA 90033, USA
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SINGLE-SESSION PHOTODYNAMIC THERAPY COMBINED WITH INTRAVITREAL BEVACIZUMAB FOR RETINAL ANGIOMATOUS PROLIFERATION. Retina 2009; 29:949-55. [DOI: 10.1097/iae.0b013e3181af106d] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Cardascia N, Furino C, Ferrara A, Boscia F, Alessio G. Treatment of recurrent retinal angiomatous proliferation with intravitreal triamcinolone acetonide followed by photodynamic therapy with verteporfin: A retrospective case series. Curr Ther Res Clin Exp 2009; 70:240-51. [PMID: 24683234 DOI: 10.1016/j.curtheres.2009.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2009] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE The aim of this study was to report the effect on tolerability of combined treatment with intravitreal triamcinolone acetonide (IVT) and photodynamic therapy (PDT) with verteporfin in patients with stage II retinal angiomatous proliferation (RAP) who had been treated previously with PDT and presented with recurrent RAP (R-RAP). METHODS This was a retrospective case series of patients with R-RAP after PDT (1-5 treatments) treated once with IVT followed 1 month later by PDT. A visual acuity test, fluorescein and indocyanine green angiography, and optical coherence tomography were performed at baseline and at 1, 3, and 6 months. RESULTS Five patients (4 men, 1 woman; mean [SD] age, 76.8 [3.9] years) with 6 eyes diagnosed with stage II R-RAP who had previously been treated with PDT and who received an IVT injection and PDT within 1 month were included in the study. Best corrected visual acuity (BCVA) remained stable after IVT in 5 eyes (83%) and deteriorated in 1 eye (17%). After PDT, BCVA remained stable in 2 eyes (33%) and deteriorated in 4 eyes (67%). IVT treatment combined with PDT also reduced fluorescein leakage. Median lesion size increased 24% before PDT and 61% at 6 months after PDT. One eye had intraocular hypertension at 3 months, and 1 eye developed a pigment epithelial tear after PDT. CONCLUSION The results were limited by the number of eyes and relatively short follow-up, but in this study, PDT after IVT did not appear to be as effective or well tolerated in 5 patients who had already been treated with PDT and presented with R-RAP.
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Affiliation(s)
- Nicola Cardascia
- Department of Ophthalmology, Policlinico of Bari, University of Bari, Bari, Italy
| | - Claudio Furino
- Department of Ophthalmology, Policlinico of Bari, University of Bari, Bari, Italy
| | - Andrea Ferrara
- Department of Ophthalmology, Policlinico of Bari, University of Bari, Bari, Italy
| | - Francesco Boscia
- Department of Ophthalmology, Policlinico of Bari, University of Bari, Bari, Italy
| | - Giovanni Alessio
- Department of Ophthalmology, Policlinico of Bari, University of Bari, Bari, Italy
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Fea A, Grosso A, Mollo M, Grignolo FM. Subfoveal choroidal neovascularization in a patient with hemicentral vein occlusion. Int Ophthalmol 2009; 30:207-10. [PMID: 19430731 DOI: 10.1007/s10792-009-9306-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2007] [Accepted: 03/19/2009] [Indexed: 12/01/2022]
Abstract
The association between choroidal neovascularization (CNV) and retinal vein occlusive disease is uncommon. Before the introduction of anti-vascular endothelial growth factor (VEGF) drugs, photodynamic therapy (PDT) was used, with conflicting functional results. We report a case of a 69-year-old male patient who came to our attention for macular edema in hemiretinal vein occlusion. Fluorescein angiogram showed presence of venous collaterals, but the pattern of the edema was atypical; optical coherence tomography (OCT) and indocyanine green angiography (ICG) were used to confirm the diagnosis of CNV. A chorio-retinal shunt was demonstrated. The autofluorescence technique was used to predict the risk of CNV in the fellow eye. PDT was performed twice, but after the second cycle, patient developed choroidal ischemia and the visual outcomes were poor. The temporal course of CNV, the presence of a chorio-retinal shunt, and the autofluorescence pattern in the fellow eye let us to speculate that the CNV was related to the vascular occlusive process. We can speculate that the overexpression of VEGF induced by local ischemia and inflammation can make these patients more likely to have CNV. However, to our knowledge, there are no accurate estimates of the incidence of CNV in other retinal vascular diseases, such as diabetic retinopathy.
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Konstantinidis L, Mameletzi E, Mantel I, Pournaras JA, Zografos L, Ambresin A. Intravitreal ranibizumab (Lucentis) in the treatment of retinal angiomatous proliferation (RAP). Graefes Arch Clin Exp Ophthalmol 2009; 247:1165-71. [PMID: 19404661 DOI: 10.1007/s00417-009-1089-3] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2009] [Revised: 03/12/2009] [Accepted: 04/06/2009] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Retinal angiomatous proliferation (RAP) is a distinct variant of neovascular age-related macular degeneration (AMD). The aim of this study is to evaluate the functional and anatomic outcome after intravitreal ranibizumab (Lucentis) treatment in patients with RAP. METHODS Prospective study of consecutive patients with newly diagnosed or recurrent RAP treated with intravitreal ranibizumab at the Jules Gonin Eye Hospital between March 2006 and December 2007. Baseline and monthly follow-up visits included best-corrected visual acuity (BCVA), fundus exam and optical coherence tomography. Fluorescein and indocyanine green angiography were performed at baseline and repeated at least every 3 months. RESULTS Thirty-one eyes of 31 patients were treated with 0.5 mg of intravitreal ranibizumab for RAP between March 2006 and December 2007. The mean age of the patients was 82.6 years (SD:4.9). The mean number of intravitreal injections administered for each patient was 5 (SD: 2.4, range 3 to 12). The mean follow up was 13.4 months (SD: 3, range 10 to 22). The baseline mean logMAR BCVA was 0.72 (SD: 0.45) (decimal equivalent of 0.2). The mean logMAR BCVA was improved significantly (P < 0.0001) at the last follow-up to 0.45, SD: 0.3 (decimal equivalent 0.35). The visual acuity (VA) improved by a mean of 2.7 lines (SD 2.5). Mean baseline central macular thickness (CMT) was 376 microm, and decreased significantly to a mean of 224 microm (P < 0.001) at the last follow-up. Mean reduction of CMT was 152 microm (SD: 58). An average of 81.5% of the total visual improvement and 85% of the total CMT reduction occurred during the first post-operative month after one intravitreal injection of ranibizumab. During follow-up, an RPE tear occurred in one eye (3.2%) of the study group. No injection complications or systemic drug-related side-effects were noted during the follow-up period. CONCLUSIONS Intravitreal ranibizumab injections appeared to be an effective and safe treatment for RAP, resulting in visual gain and reduction in macular thickness. Further long-term studies to evaluate the efficacy of intravitreal ranibizumab in RAP are warranted.
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INTRAVITREAL RANIBIZUMAB, INTRAVITREAL RANIBIZUMAB WITH PDT, AND INTRAVITREAL TRIAMCINOLONE WITH PDT FOR THE TREATMENT OF RETINAL ANGIOMATOUS PROLIFERATION. Retina 2009; 29:536-44. [DOI: 10.1097/iae.0b013e318196b1de] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Saito M, Shiragami C, Shiraga F, Nagayama D, Iida T. Combined intravitreal bevacizumab and photodynamic therapy for retinal angiomatous proliferation. Am J Ophthalmol 2008; 146:935-41.e1. [PMID: 18723139 DOI: 10.1016/j.ajo.2008.06.033] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2008] [Revised: 06/25/2008] [Accepted: 06/30/2008] [Indexed: 11/29/2022]
Abstract
PURPOSE To clarify the efficiency of combined therapy with intravitreal bevacizumab injections and photodynamic therapy (PDT) in patients with retinal angiomatous proliferation (RAP). DESIGN Retrospective, observational, consecutive case series. METHODS We retrospectively reviewed 11 consecutive eyes with RAP (10 patients; six men, four women) treated with intravitreal bevacizumab injection and PDT. Patients ranged in age from 63 to 89 years old (average, 79 years). No patients had undergone previous treatment, and patients were followed for at least six months. PDT was applied one or two days after the intravitreal bevacizumab (1.25 mg) injection. RESULTS The mean best-corrected visual acuity (BCVA) levels at baseline and one, three, and six months after treatment were 0.16, 0.27, 0.31, and 0.29, respectively. A significant improvement in the mean BCVA was observed one, three, and six months after intravitreal bevacizumab injection and PDT (P < .01). The mean improvement in BCVA six months from baseline was 2.64 lines. The BCVA at six months improved in six eyes (54.5%, improved by three lines or more) and was stable in five eyes (45.5%). No patient had a decrease in the BCVA of three or more lines during any six months. The central retinal thickness significantly decreased from 496 +/- 189 microm to 175 +/- 33 microm at six months (P < .001). No patients required retreatment during any six months. No complications such as severe vision loss, endophthalmitis, or systemic events developed. CONCLUSION Combined intravitreal bevacizumab and PDT for RAP effectively maintained or improved VA and reduced or eliminated edema in the short-term.
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Affiliation(s)
- Masaaki Saito
- Department of Ophthalmology, Fukushima Medical University School of Medicine, Fukushima, Japan.
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Montero JA, Ruiz-Moreno JM, Sanabria MR, Fernandez-Munoz M. Efficacy of intravitreal and periocular triamcinolone associated with photodynamic therapy for treatment of retinal angiomatous proliferation. Br J Ophthalmol 2008; 93:166-70. [DOI: 10.1136/bjo.2008.141903] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Kang JH, Park KA, Chung SE, Kang SW. Retinal angiomatous proliferation and intravitreal bevacizumab injection. KOREAN JOURNAL OF OPHTHALMOLOGY 2008; 21:213-5. [PMID: 18063885 PMCID: PMC2644089 DOI: 10.3341/kjo.2007.21.4.213] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate the short-term efficacy and safety of intravitreal bevacizumab injection (IVBI) in patients with retinal angiomatous proliferation (RAP). Methods Seven eyes of 5 patients with RAP were included in this study. All of the eyes evidenced stage 2 RAP lesions, except for one eye with a stage 3 lesion. IVBI (1.25 mg/0.05 cc) were conducted at 4 or 6-week intervals. Complete ocular examinations, angiographic results and optical coherence tomographic findings before and after the IVBI were analyzed at baseline and upon the follow-up visits. Results Seven eyes were studied in 5 patients who had undergone IVBI. Partial (3 eyes) or complete (4 eyes) regression of RAP was noted after IVBI in all of the studied eyes. Visual acuity improved in 5 of the eyes, and was stable in 2 of the eyes. One eye evidenced severe intraocular inflammation after IVBI and a subsequent development of new RAP, which was controlled with vitrectomy and repeat IVBI. Conclusions This treatment was effective over 6 months, stabilizing or improving visual acuity and reducing angiographic leakage. These short-term results suggest that IVBI may constitute a promising therapeutic option, particularly in the early stages of RAP.
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Affiliation(s)
- Jae Hoon Kang
- Department of Ophthalmology, Samsung Medical Center, College of Medicine, Sungkyunkwan University, Seoul, Korea
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Rouvas AA, Papakostas TD, Ladas ID, Vergados I. Enlargement of the hypofluorescent post photodynamic therapy treatment spot after a combination of photodynamic therapy with an intravitreal injection of bevacizumab for retinal angiomatous proliferation. Graefes Arch Clin Exp Ophthalmol 2007; 246:315-8. [DOI: 10.1007/s00417-007-0669-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2007] [Revised: 07/20/2007] [Accepted: 08/02/2007] [Indexed: 01/29/2023] Open
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Abstract
Mainstream uses for photodynamic therapy (PDT) in dermatology include nonmelanoma skin cancer and its precursors, acne vulgaris, photorejuvenation, and hidradenitis suppurativa. Many other dermatologic entities have been treated with PDT, including psoriasis, lichen planus, lichen sclerosus, scleroderma, cutaneous T cell lymphoma, alopecia areata, verruca vulgaris, Darier's disease and tinea infections. Nondermatologic applications include anal and vulva carcinoma, palliation of metastatic breast cancer to skin, Barrett's esophagus, and macular degeneration of the retina. PDT also has found to be useful in immunologic and inflammatory disorders, neoplasias other than skin cancer, and infections. The ability of this treatment to hone in on dysplastic epithelial and endothelial cells while retaining viability of surrounding tissue is its key feature because this leads to specific tumor destruction with cosmesis and function of the target organ intact.
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Affiliation(s)
- Amy Forman Taub
- Department of Dermatology, Northwestern University Medical School, 676 St. Clair Street, Chicago, IL 60611, USA.
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