Geographic Atrophy in Retinal Angiomatous Proliferation

McBain, Vikki A.; Kumari, Reema; Townend, John; Lois, Noemi

doi:10.1097/iae.0b013e3181fe54c7

Cited by 73 publications

(50 citation statements)

References 25 publications

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“…Even though this was not observed in our cohort, 27 eyes (34.2%) presented with some degree of GA at baseline, and this number rose to 47 at the last visit (59.5%). McBain et al [28] reported GA development in 53% (n = 35) of RAP eyes, independently of the treatment chosen (IV anti-VEGF and/or PDT), a result that supports our findings. The aforementioned CATT research group paper [27] also focused on the risk factors for the development of GA and found that the RAP subtype of AMD accounted for a 1.69-fold risk of GA development.…”

Section: Discussionsupporting

confidence: 82%

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: Discussionsupporting

confidence: 82%

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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“…31,32 In the present study, 17.7% (11 of 62) of eyes exhibited type 3 NV. Retinal angiomatous proliferation has been reported to follow a more aggressive natural course than type 1 or 2 NV, despite the excellent response to anti-VEGF therapy with a dramatic reduction in CMT and intraretinal edema.…”

Section: Discussionmentioning

confidence: 92%

“…Retinal angiomatous proliferation has been reported to follow a more aggressive natural course than type 1 or 2 NV, despite the excellent response to anti-VEGF therapy with a dramatic reduction in CMT and intraretinal edema. 32,33 The occurrence of high rates of RPE atrophy at presentation and the development of new atrophy or geographic atrophy during follow-up have also been described. 32,34 Intriguingly, the WIF-1 level was by far the highest in patients with type 3 NV in this study.…”

Section: Discussionmentioning

confidence: 99%

“…32,33 The occurrence of high rates of RPE atrophy at presentation and the development of new atrophy or geographic atrophy during follow-up have also been described. 32,34 Intriguingly, the WIF-1 level was by far the highest in patients with type 3 NV in this study. This result may suggest that the retina is markedly damaged during the course of RAP; this assertion is supported by the disrupted IS/OS on SD-OCT, which indicates that the retina and, particularly, the photoreceptors are damaged.…”

Section: Discussionmentioning

confidence: 99%

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Wnt Modulators in the Aqueous Humor Are Associated With Outer Retinal Damage Severity in Patients With Neovascular Age-Related Macular Degeneration

Park

Choi

Yoon

et al. 2014

Invest. Ophthalmol. Vis. Sci.

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Citation: Park KH, Choi AJ, Yoon J, et al. Wnt modulators in the aqueous humor are associated with outer retinal damage severity in patients with neovascular age-related macular degeneration. Invest Ophthalmol Vis Sci. 2014;55:5522-5530. DOI: 10.1167/iovs.14-14566 PURPOSE. To investigate the associations of the Wnt modulators Wnt inhibitory factor 1 (WIF-1) and Dickkopf 3 (DKK-3) in the aqueous humor with neovascular age-related macular degeneration (nAMD) and to determine their clinical implications.METHODS. Seventy-four nAMD patients initially treated with an intravitreal injection of ranibizumab (IVR) and 74 age-and sex-matched controls were studied. Aqueous humor WIF-1 and DKK-3 levels were measured by Western blotting and an ELISA before and 1 month after two consecutive IVRs (pre-and post-IVR). Visual acuity assessments and spectral domain optical coherence tomography were performed pre-and post-IVR. RESULTS.Western blotting showed increased WIF-1 and DKK-3 in 12 nAMD patients compared with 12 controls. The ELISA analysis demonstrated elevated WIF-1 (pre) and DKK-3 (pre) in 62 patients compared with 62 controls (54.7 vs. 23.0 and 114.3 vs. 93.0 ng/mL, respectively). In multivariate analyses, high WIF-1 (pre) levels were associated with increased disruption in the photoreceptor junction's inner and outer segments (IS/OS) (pre and post) and high WIF-1 (post) levels. Interestingly, WIF-1 (pre) levels were significantly higher in type 3 neovascularization (NV) patients than in type 1 or 2 NV (90.5 6 36.7 vs. 48.3 6 22.5 and 41.3 6 28.8 ng/mL, respectively). However, choroidal thickness was not correlated with WIF-1 levels.CONCLUSIONS. We report, for the first time, the possibility of phenotypic, anatomic, and ocular proteomic correlations, demonstrating correlated WIF-1 and DKK-3 upregulation in nAMD patients' aqueous humor. Secreted WIF-1, reflecting the degree of retinal structure damage, may be a new biomarker for the retina's healthy and disease states.

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“…8 Also, RAP is highly associated with geographic atrophy. 9 Therefore, we believe that the anti-VEGF agent, which has a minimum effect on the choroid, is better to be used for the treatment of RAP. Atul Kumar: Diagnosis is based on clinical presentation described above, and further confirmed on OCT. One of the major differentials for AOFVD is Best's macular dystrophy.…”

Section: Hidetaka Matsumotomentioning

confidence: 99%

Thinking Beyond Wet Age-Related Macular Degeneration

Goel¹

2016

DJO

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Wet age-related macular degeneration (AMD), also known as neovascular or exudative AMD is the commonest cause of choroidal neovascularization at the macula. However, several entities mimic wet AMD, which can be distinguished on careful clinical examination and relevant imaging modalities. A high index of suspicion is required to identify these mimickers early in the course of the disease, which can otherwise be missed. Their recognition is of importance owing to varying management strategies and prognosis vis-à-vis wet AMD.Neha Goel -Q. What are the mimickers / variants of wet AMD encountered in your practice, and how frequently (in percentage)?Atul Kumar: We prefer using the term Neovascular AMD instead of wet AMD, as the latest internationally accepted nomenclature. Differentials of neovascular AMD (nAMD) include conditions which have features similar to choroidal neovascularization (CNV) at post pole. Conditions with CNV which mimic nAMD that we see commonly include: Polypoidal Choroidal Vasculopathy (PCV), Retinal Angiomatous Proliferation (RAP), and Macular Telangiectasia (Mac Tel). PCV is seen about 8-15% cases of nAMD, and RAP in approximately 5% cases at our centre. Besides these, Multifocal choroiditis typically presents as a chronic relapsing panuveitis with multiple chorioretinal lesions -and is the most common entity presenting with Idiopathic CNV (1-5% at our centre), pseudoxanthoma elasticum also has CNV as its major complication (seen between 1-2% at RP Centre). Pathologic myopia, or high myopia, is an important cause of secondary CNV in young people .The progressive elongation of the eye is associated with variable morphologic alterations within a posterior staphyloma. Macular CNV is the most common vision-threatening complication of high myopia seen by us, affecting nearly 8-10 percent of patients here. Mahesh P Shanmugam: Polypoidal choroidal vasculopathy -70%CNVM of other etiology -myopic, idiopathic, associated with parafoveal telangiectasia -20% Retinal angiomatous proliferation -5% Adult Onset Foveomacular Vitelliform Dystrophy (AOFVD), other pattern dystrophies, subfoveal lymphoma or early choroidal metastasis -5%. MunaBhende: PCV, Chronic Central Serous Chorioretinopathy (CSR), vitelliform lesions, other CNV etiologies. I would consider RAP as a subset of AMD.Raja Narayanan: The common variants of wet AMD are PCV, RAP and AOFVD. PCV comprises 40-50% of cases, stage 1 and 2 RAP constitutes approximately 10% cases, and AOFVD represents less than 5% cases. The remaining 35-

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Geographic Atrophy in Retinal Angiomatous Proliferation

Cited by 73 publications

References 25 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

Wnt Modulators in the Aqueous Humor Are Associated With Outer Retinal Damage Severity in Patients With Neovascular Age-Related Macular Degeneration

Thinking Beyond Wet Age-Related Macular Degeneration

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