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Huang YY, Lo WJ, Chang HY, Chou YB, Lin TC. Three-Year Outcomes of Intravitreal Aflibercept Injections for Retinal Angiomatous Proliferation According to Disease Stage. Ophthalmol Ther 2022; 11:1503-1516. [PMID: 35596037 PMCID: PMC9253227 DOI: 10.1007/s40123-022-00521-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 04/29/2022] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION To evaluate the outcomes of intravitreal aflibercept injections for retinal angiomatous proliferation (RAP) according to disease stage. METHODS This retrospective chart review included 68 eyes of 53 individuals diagnosed as having RAP and 109 neovascular age-related macular degeneration (nAMD) eyes of 109 patients as controls. All patients received intravitreal injections of aflibercept in a real-world setting. The main outcome measures were the changes in the mean of best-corrected visual acuity (BCVA) and central retinal thickness (CRT) as well as the total number of injections received during the 3-year follow-up period. RESULTS The average BCVA and CRT changes in eyes affected by RAP and the controls at 3 years were non-significant. Both populations received a similar number of injections. After 3 years of treatment, patients with RAP had visual decline despite stable anatomical outcomes. Approximately 50% of the eyes with stage II RAP exhibited significant BCVA decline at the end of the third year. Among those eyes that had deteriorated BCVA, persistently worsening BCVA and thinning CRT were observed from year 2 to year 3. CONCLUSION Similar to treating nAMD, intensive injections or aggressive treatment strategies are required to treat RAP to achieve optimal visual outcomes in a real-world setting. The response to aflibercept treatment at the second year is associated with the final visual outcome of eyes with stage II RAP lesions.
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Affiliation(s)
- Ya-Yun Huang
- Department of Medical Education and Research, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China.,Department of Ophthalmology, Taipei Veterans General Hospital, 201, Sec. 2, Shih-Pai Road, Taipei, Taiwan, Republic of China
| | - Wen-Jung Lo
- Department of Ophthalmology, Taipei Veterans General Hospital, 201, Sec. 2, Shih-Pai Road, Taipei, Taiwan, Republic of China
| | - Hsin-Yi Chang
- Department of Ophthalmology, Shin Kong Wu Ho Su Memorial Hospital, Taipei, Taiwan, Republic of China
| | - Yu-Bai Chou
- Department of Ophthalmology, Taipei Veterans General Hospital, 201, Sec. 2, Shih-Pai Road, Taipei, Taiwan, Republic of China.,Department of Ophthalmology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, Republic of China
| | - Tai-Chi Lin
- Department of Ophthalmology, Taipei Veterans General Hospital, 201, Sec. 2, Shih-Pai Road, Taipei, Taiwan, Republic of China. .,Department of Ophthalmology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, Republic of China.
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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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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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Abstract
BACKGROUND Retinal angiomatous proliferations (RAP) are a subgroup of exsudative or "wet" age-related macular degeneration (wAMD) with devastating reduction of visual acuity in later stages. Intravitreal ranibizumab provides good therapy, but is considered to be less effective than in other choroidal neovascularizations (CNV). OBJECTIVE We investigated the efficacy of ranibizumab in late-stage III RAP with retinochoroidal anastomosis compared to the outcome of other CNV lesions. MATERIALS AND METHODS The data of all patients with wAMD treated with ranibizumab were retrospectively analyzed. Patients were divided into groups depending on the lesion type into RAP (identified and selected clinically, proven by fluorescein angiography) and CNV lesions (identified by fluorescein angiography only) named occult, minimally and predominantly classic groups. The best-corrected visual acuity (BCVA) was obtained before (at the timepoint "diagnosis"), during (1st, 2nd, and 3rd injection), and after upload ("1st control"). RESULTS Before first injection, visual acuity decreased in all groups (0.73 to 0.78 logMAR for all CNV, 0.95 to 1.02 logMAR for RAP). During upload there was no further decline in visual acuity but no improvement as well up to the 1st control visit in the RAP group (1.02 to 1.03 logMAR), but a statistically significant increase in all other groups (0.78 to 0.67 logMAR). CONCLUSION Treatment of late-stage III RAP with ranibizumab is effective. Stabiliziation of visual acuity can be achieved, but-in contrast to other forms of CNV lesions-no further improvement. Therefore, patients with this special form need to be identified and treated as early as possible.
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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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How has high-resolution multimodal imaging refined our understanding of the vasogenic process in type 3 neovascularization? Retina 2015; 35:603-13. [PMID: 25621948 DOI: 10.1097/iae.0000000000000487] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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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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11
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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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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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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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Rishi P, Dhupper M, Rishi E. Can retinal microtrauma by internal limiting membrane peeling cause retinal angiomatosis proliferans? Oman J Ophthalmol 2012; 4:144-6. [PMID: 22279405 PMCID: PMC3263170 DOI: 10.4103/0974-620x.91273] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
A 32-year-old male presented with decreased vision in right eye since 1 month following trauma with plastic ball. Best-corrected visual acuity (BCVA) was 20/160 in right eye and 20/20 in left. Right eye examination revealed angle recession, choroidal rupture, and macular hole. He underwent vitrectomy, internal limiting membrane (ILM) peeling, and 14% C3F8 gas injection. After 6 weeks, BCVA was 20/30; fundus showed macular hole closure. Six months after surgery, fundus revealed retinal vascular lesions suggestive of stage I RAP-like lesions; vision was maintained. Clinical findings were confirmed on Video ICGA, FFA, and OCT. The patient was periodically reviewed and lesions were nonprogressive until last follow-up, 13 months after surgery. It seems quite probable that ILM peeling may have caused retinal microtrauma leading to the formation of RAP-like lesions. What factors lead to such an event is as yet not clearly understood. Hence, larger studies with a longer follow-up are warranted to better understand these findings.
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Affiliation(s)
- Pukhraj Rishi
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
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Ranibizumab in Retinal Angiomatous Proliferation (RAP): Influence of RAP Stage on Visual Outcome. Eur J Ophthalmol 2011; 21:783-8. [DOI: 10.5301/ejo.2011.6526] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2011] [Indexed: 11/20/2022]
Abstract
Purpose. To evaluate the influence of retinal angiomatous proliferation (RAP) stage on visual and anatomic outcome after ranibizumab (Lucentis®). Methods. This was a prospective study on consecutively diagnosed RAP eyes at the Hospital Clínico San Carlos, Madrid. Best-corrected visual acuity (BCVA) and optical coherence tomography (OCT) are performed monthly. Indocyanine green angiography (ICG) and fluorescein angiography (FA) are performed at baseline and every 3 months thereafter. A starting dose of a monthly ranibizumab injection in the first 3 months is followed by retreatment in case of intraretinal edema, subretinal fluid, or pigment epithelium detachment (PED) in OCT, increased leakage in FA, or a hot spot in ICG. Results. A total of 53 eyes from 49 patients were included. The mean change in BCVA at 12 months was +7.3, +0.83, and −2.1 letters in stages IIA (21 cases), Il B (18 cases), and III (14 cases), respectively. After adjusting the change in BCVA according to baseline BCVA, β coefficient was −6.012 letters (p=0.025) in stage IIB and −9.762 letters (p=0.003) in stage III vs stage IIA. Four cases had a retinal pigment epithelium tear after injection of ranibizumab. Conclusions. Patients in stage II without PED have a better visual and anatomic evolution than patients in stage II with PED and stage III.
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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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Campa C, Harding SP, Pearce IA, Beare NAV, Briggs MC, Heimann H. Incidence of neovascularization in the fellow eye of patients with unilateral retinal angiomatous proliferation. Eye (Lond) 2010; 24:1585-9. [DOI: 10.1038/eye.2010.88] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
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Sequential combined treatment with intravitreal bevacizumab and photodynamic therapy for retinal angiomatous proliferation. Eye (Lond) 2010; 24:1344-51. [DOI: 10.1038/eye.2010.33] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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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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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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Wolf A, Kook D, Kreutzer T, Gandorfer A, Haritoglou C, Kampik A, Ulbig M. Intravitreale Anti-VEGF-Behandlung retinaler angiomatöser Proliferationen. Ophthalmologe 2008; 105:845-51. [DOI: 10.1007/s00347-008-1785-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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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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Abstract
BACKGROUND Retinal angiomatous proliferation (RAP) is a distinct form of neovascularization in patients with age-related macular degeneration. Lacking definitive sequential histopathologic evidence of its intraretinal versus choroidal origin, the clinical observations of early stages of RAP lesions may provide clues to help further expand our understanding of this entity. METHODS Five eyes of four patients with early Stage 1 RAP were examined. Fundus photography, fluorescein and indocyanine green angiography as well as time-domain and spectral-domain optical coherence tomography were performed. Images were assessed to determine the characteristics of neovascularization in early stage RAP lesions and the response of the lesions to treatment or observation. RESULTS The analysis of the selected cases suggests a choroidal origin of the neovascular complex with the early formation of a retinal choroidal anastomosis without evidence of underlying occult Type 1 neovascularization. Three eyes responded to a single treatment with intravitreal ranibizumab (0.5 mg) and 2 eyes (1 patient) resolved spontaneously without treatment. CONCLUSION The neovascularization in RAP may originate not only from deep retinal capillaries but also from the choroid. We therefore propose the more descriptive term "Type 3 neovascularization" for this entity to emphasize the intraretinal location of the vascular complex and distinguish this type from the two types of neovascularization previously described by J. Donald Gass in his classic text.
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Costagliola C, Romano MR, dell'Omo R, Cipollone U, Polisena P. Intravitreal bevacizumab for the treatment of retinal angiomatous proliferation. Am J Ophthalmol 2007; 144:449-51. [PMID: 17765426 DOI: 10.1016/j.ajo.2007.05.025] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2007] [Revised: 05/15/2007] [Accepted: 05/16/2007] [Indexed: 02/06/2023]
Abstract
PURPOSE To verify the potential efficacy of intravitreal bevacizumab (IVB) injections for the treatment of retinal angiomatous proliferation (RAP). DESIGN Retrospective interventional case series. METHODS Four consecutive patients affected by RAP at different stages and refractory to photodynamic therapy (PDT). All patients underwent a complete ophthalmic examination including best-corrected visual acuity (BCVA), fluorescein and indocyanine green angiographies, and optical coherence tomography (OCT) at baseline, and after one, three, six, nine, and 12 months. All patients received IVB injections (1.25 mg/0.05 ml). RESULTS The best functional response has been achieved in patients with RAP at stages 1 and 2; whereas in stage 3, a detectable recovery of visual acuity was not observed. This improvement was stable over the follow-up period with a concomitant reduction of macular thickness. CONCLUSIONS The use of IVB in patients affected by RAP seems to exert morphologic benefits at all RAP stages that does not always correspond a functional improvement.
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Affiliation(s)
- Ciro Costagliola
- Dipartimento di Scienze per la Salute, Università degli Studi del Molise, Campobasso, Italy
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