Current treatment options for retinal angiomatous proliferans (RAP)

Gupta, Bhaskar; Jyothi, S.; Sivaprasad, Sobha

doi:10.1136/bjo.2009.166975

Cited by 30 publications

(22 citation statements)

References 39 publications

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“…Retinal angiomatous proliferation (RAP), also known as type 3 neovascularization, is a well-recognized neovascular phenotype of age-related macular degeneration (AMD), accounting for 12-15% of its exudative form in Caucasians [1]. The angioproliferative process associated with RAP diverges from other neovascular membranes, as it is believed to start deeply within the retina [2,3,4,5,6].…”

Section: Introductionmentioning

confidence: 99%

“…Reports on intravitreal (IV) ranibizumab, either in monotherapy or with concomitant photodynamic therapy (PDT), have underlined the responsiveness of RAP lesions to both treatment modalities [18,19,20,21]. However, standard protocols for the management of the disease are currently not available [1], and published data are limited to small case series with short follow-up periods [18,19,20,21]. …”

Section: Introductionmentioning

confidence: 99%

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Long-Term Management of RAP Lesions in Clinical Practice: Treatment Efficacy and Predictors of Functional Improvement

Marques

Gil

et al. 2015

Ophthalmic Res

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Purpose: To evaluate the long-term efficacy of ranibizumab in the treatment of retinal angiomatous proliferation (RAP) and to identify predictors of functional outcome. Methods: Retrospective case series comprised 79 eyes of 68 consecutive patients with RAP followed up ≥36 months. Primary end-points were best-corrected visual acuity (BCVA) and central macular thickness (CMT) variation at 36 months and at the last visit. Results: Mean follow-up time was 59.8 ± 16.0 months. All eyes were treated with pro re nata ranibizumab, with (n = 33) or without (n = 46) photodynamic therapy (PDT). Stabilization or improvement in BCVA was observed in 50.6% of the patients at 36 months, and in 40.5% at the end of the follow-up, where 20.3% preserved reading vision. A significant decrease in CMT was observed at 36 months (p < 0.001), but not at the end of the follow-up. Geographic atrophy (GA) was present in 59.5% of the eyes at the final visit. Baseline subretinal fluid was associated with better visual outcomes (p = 0.001). Results of combination treatment with intravitreal ranibizumab and PDT did not significantly differ from ranibizumab monotherapy. Conclusion: Modest functional outcomes can be expected from the long-term treatment of RAP lesions in clinical practice, most likely due to the advent of GA. Baseline subretinal fluid positively correlated with final BCVA.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Long-Term Management of RAP Lesions in Clinical Practice: Treatment Efficacy and Predictors of Functional Improvement

Marques

Gil

et al. 2015

Ophthalmic Res

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“…Several studies have reported a poor response to PDT monotherapy in patients with RAP lesions 6,7. Hence, it is common to perform PDT combined with intravitreal injections of triamcinolone acetonide (IVT) or anti-VEGF therapy for RAP 8,9. Several studies were conducted to address the comparative effectiveness between PDT monotherapy and the combination of PDT with IVT or anti-VEGF therapy against RAP lesions, but their conclusions were not consistent.…”

Section: Introductionmentioning

confidence: 99%

Effect of photodynamic therapy (PDT), posterior subtenon injection of triamcinolone acetonide with PDT, and intravitreal injection of ranibizumab with PDT for retinal angiomatous proliferation

Nakano¹,

Honda²,

Oh³

et al. 2012

OPTH

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BackgroundThe 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).MethodsThirty-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.ResultsThe 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.ConclusionTreatment with STA + PDT may be an effective therapy for RAP lesions over 12 months of follow-up.

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“…Hierbei entstammt die neovaskuläre Membran nicht primär der Choriokapillaris, sondern breitet sich entgegengerichtet, aus den retinalen Gefäßen entspringend, Richtung Choroidea aus [3]. Bezüglich des am besten geeigneten therapeutischen Vorgehens ist bei dieser, auch als Typ-3-Neovaskularisation bezeichneten Form aktuell kein Goldstandard etabliert [3,4].…”

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Langzeitbehandlung von RAP-Läsionen

Treder¹

2016

Kompass Ophthalmol

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Ziel: Beurteilung der langfristigen Wirksamkeit von Ranibizumab in der Behandlung der retinalen angiomatösen Proliferation (RAP) und Identifikation von Prädiktoren für das funktionelle Behandlungsergebnis. Methoden: Retrospektive Fallserie mit 79 Augen von 68 konsekutiven Patienten mit RAP, die über ≥36 Monate nachbeobachtet wurden. Primäre Endpunkte waren die Veränderung der besten korrigierten Sehschärfe (Visus c. c.) und der zentralen Netzhautdicke nach 36 Monaten und beim letzten Termin. Ergebnisse: Die mittlere Nachbeobachtungsdauer betrug 59,8 ± 16,0 Monate. Alle Augen wurden mit Ranibizumab pro re nata behandelt; mit (n = 33) oder ohne (n = 46) begleitende photodynamische Therapie (PDT). Eine Stabilisierung oder Verbesserung des Visus c. c. lag nach 36 Monaten bei 50,6% der Patienten vor und am Ende der Nachbeobachtung bei 40,5%, wobei bei 20,3% das Lesevermögen erhalten blieb. Eine signifikante Abnahme der zentralen Netzhautdicke war nach 36 Monaten festzustellen (p < 0,001), nicht jedoch am Ende des Nachbeobachtungszeitraums. Eine geographische Atrophie (GA) lag beim letzten Termin in 59,5% der Augen vor. Subretinale Flüssigkeit zu Studienbeginn war mit einem besseren visuellen Outcome assoziiert (p = 0,001). Die Ergebnisse der Kombinationstherapie mit intravitrealem Ranibizumab und PDT unterschieden sich nicht signifikant von denen der Ranibizumab-Monotherapie. Schlussfolgerung: Von der Langzeittherapie bei RAP-Läsionen sind in der klinischen Praxis bescheidene Erfolge zu erwarten, was vermutlich auf das Auftreten von GA zurückzuführen ist. Subretinale Flüssigkeit zu Studienbeginn korrelierte positiv mit dem Visus c. c. am Ende der Studie. Übersetzung aus Ophthalmologica 2016;55:119-125 (DOI:10.1159/000441797)

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Current treatment options for retinal angiomatous proliferans (RAP)

Cited by 30 publications

References 39 publications

Long-Term Management of RAP Lesions in Clinical Practice: Treatment Efficacy and Predictors of Functional Improvement

Long-Term Management of RAP Lesions in Clinical Practice: Treatment Efficacy and Predictors of Functional Improvement

Effect of photodynamic therapy (PDT), posterior subtenon injection of triamcinolone acetonide with PDT, and intravitreal injection of ranibizumab with PDT for retinal angiomatous proliferation

Langzeitbehandlung von RAP-Läsionen

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