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de Jong JH, Braaf B, Amarakoon S, Gräfe M, Yzer S, Vermeer KA, Missotten T, de Boer JF, van Velthoven MEJ. Treatment Effects in Retinal Angiomatous Proliferation Imaged with OCT Angiography. Ophthalmologica 2018; 241:143-153. [PMID: 30227415 DOI: 10.1159/000491798] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 07/04/2018] [Indexed: 11/19/2022]
Abstract
PURPOSE This prospective case series is aimed at exploring optical coherence tomographic angiography (OCT-A) as a treatment monitoring tool in patients treated for retinal angiomatous proliferation (RAP). METHODS Twelve treatment-naïve RAP patients were included, with a median age of 79 years (range 65-90). Patients were imaged with an experimental 1,040-nm swept-source phase-resolved OCT-A instrument before and after treatment. Treatment consisted of either intravitreal bevacizumab or triamcinolone injections with or without photodynamic therapy (PDT). Abnormal blood flow after treatment was graded as increased, unchanged, decreased, or resolved. RESULTS OCT-A images before and after treatment could be obtained in 9 patients. The median follow-up period was 10 weeks (range 5-19). After various treatments, the RAP lesion resolved in 7 patients, in 1 patient the OCT-A depicted decreased flow in the lesion, and 1 patient showed unchanged abnormal blood flow. Monotherapy with intravitreal bevacizumab injections resolved RAP in 1 out of 2 patients. Combined therapy of bevacizumab with PDT resolved RAP in 6 out of 7 patients. CONCLUSIONS OCT-A visualized resolution of abnormal blood flow in 7 out of 9 RAP patients after various short-term treatment sequences. OCT-A may become an important noninvasive monitoring tool for optimizing treatment strategies in RAP patients.
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Affiliation(s)
- Jan H de Jong
- Rotterdam Ophthalmic Institute, Rotterdam, The Netherlands.,Rotterdam Eye Hospital, Rotterdam, The Netherlands
| | - Boy Braaf
- Institute for Lasers, Life and Biophotonics Amsterdam, Department of Physics and Astronomy, VU University, Amsterdam, The Netherlands
| | - Sankha Amarakoon
- Rotterdam Ophthalmic Institute, Rotterdam, The Netherlands.,Rotterdam Eye Hospital, Rotterdam, The Netherlands
| | - Maximilian Gräfe
- Institute for Lasers, Life and Biophotonics Amsterdam, Department of Physics and Astronomy, VU University, Amsterdam, The Netherlands
| | - Suzanne Yzer
- Rotterdam Ophthalmic Institute, Rotterdam, The Netherlands.,Rotterdam Eye Hospital, Rotterdam, The Netherlands
| | | | - Tom Missotten
- Rotterdam Ophthalmic Institute, Rotterdam, The Netherlands.,Rotterdam Eye Hospital, Rotterdam, The Netherlands
| | - Johannes F de Boer
- Rotterdam Ophthalmic Institute, Rotterdam, The Netherlands.,Institute for Lasers, Life and Biophotonics Amsterdam, Department of Physics and Astronomy, VU University, Amsterdam, The Netherlands
| | - Mirjam E J van Velthoven
- Rotterdam Ophthalmic Institute, Rotterdam, The Netherlands, .,Rotterdam Eye Hospital, Rotterdam, The Netherlands,
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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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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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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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Maier M, Perz C, Bockmaier J, Feucht N, Lohmann C. Therapie der retinalen angiomatösen Proliferation im Stadium III. Ophthalmologe 2012; 110:1171-8. [DOI: 10.1007/s00347-012-2732-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Kramann CA, Schöpfer K, Lorenz K, Zwiener I, Stoffelns BM, Pfeiffer N. Intravitreal ranibizumab treatment of retinal angiomatous proliferation. Acta Ophthalmol 2012; 90:487-91. [PMID: 20584002 DOI: 10.1111/j.1755-3768.2010.01952.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE To determine the efficacy of intravitreal injections of ranibizumab in the treatment of retinal angiomatous proliferation (RAP) in neovascular age-related macular degeneration. METHODS Retrospective, consecutive case series of 26 eyes (26 patients) treated with intravitreal injections of 0.5 mg ranibizumab for RAP. Patients received intravitreal injections at monthly intervals during upload phase for a 3-month period. RESULTS Mean visual acuity before treatment was 0.75 ± 0.38logMAR (mean ± SD, n = 26). In the upload phase, mean visual acuity improved 4 weeks after the initial injection to 0.6 ± 0.37logMAR (n = 26) and to 0.53 ± 0.34logMAR (n = 26) 4 weeks after the third monthly intravitreal injection of ranibizumab. The mean optical coherence tomography (OCT) central foveal thickness reduced from 345 ± 55 μm at baseline to 215 ± 87 μm at 3 months. In the maintenance phase, mean visual acuity after 6 months was 0.66 ± 0.38logMAR (n = 12) and 0.7 ± 0.37logMAR after 9 months (n = 6). The mean OCT central foveal thickness was 259 ± 59 μm (n = 13) at 6 months and 280 ± 127 μm (n = 6) at nine-month follow-up. CONCLUSION Intravitreal ranibizumab resulted in an improvement of visual acuity 4 weeks after the first injection but was more pronounced after 3 months. A reduction in leakage and OCT central foveal thickness was seen 3 months after the commencement of treatment.
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Affiliation(s)
- Christina A Kramann
- Department of Ophthalmology, University Medical Center Mainz, Johannes Gutenberg University, Mainz, Germany
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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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“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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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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Early response of retinal angiomatous proliferation treated with intravitreal pegaptanib: a retrospective review. Eye (Lond) 2008; 23:530-5. [PMID: 18425070 DOI: 10.1038/eye.2008.101] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
AIMS To evaluate the early functional and anatomical responses to intravitreal pegaptanib in patients with retinal angiomatous proliferation (RAP). METHODS Retrospective review of consecutive patients newly diagnosed with RAP treated with intravitreal pegaptanib (0.3 mg). Examination at baseline and 12 weekly intervals included refraction protocol best corrected visual acuity (BCVA), fluorescein angiography (FA), and optical coherence tomography (OCT). At intervening 6 weekly visits a reduced protocol assessment included BCVA and OCT. RESULTS A total of 16 eyes of 16 patients (12 female, mean age 76.0 years) with RAP at baseline (15 stage 3, one stage 2) were treated. One patient had poor response, losing 20 ETDRS letters after one injection and was switched to photodynamic therapy combined with intravitreal triamcinolone. Mean BCVA (n=15) was baseline 45+/-11 (mean+/-SD) letters, 12 weeks 43+/-14 letters, 24 weeks 40+/-14 letters; the reduction from baseline to 24 weeks was statistically significant (P=0.04). Vision remained stable defined as +/-15 letters of baseline BCVA in 13 (87%) of patients 2 (13%) lost >15 letters. Mean OCT central foveal thickness (CFT) (n=13) was: baseline 325+/-123 microm, 12 weeks 343+/-130 microm, 24 weeks 321+/-115 microm; difference at 24 weeks was not statistically significant (P=0.9). A pigment epithelial detachment was present in 12 cases; height was reduced in 10 cases at 24 weeks. Persistent leakage on FA was seen in 13 out of 15 cases at 24 weeks. CONCLUSION Early results of treatment of RAP with intravitreal pegaptanib suggest some stabilizing effect on this normally progressive disease.
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