Long-term visual and anatomical outcomes following anti-VEGF monotherapy for retinal angiomatous proliferation

Abstract

Purpose-To study the long-term visual and anatomic outcomes of anti-vascular endothelial growth factor (VEGF) monotherapy for the treatment of patients with retinal angiomatous proliferation (RAP). Methods-Retrospective review of patients who were diagnosed with AMD and RAP lesions, and who received anti-VEGF injections as the only mode of therapy.Results-20 eyes (15 patients; 9 women, 6 men) with RAP lesions treated by anti-VEGF were encountered. Mean patient age was 85.8 years (SD ± 4.54). Nine eyes were treated with intravitreal ranibizumab alone, 8 eyes with bevacizumab alone, and 3 eyes received both drugs. At the 1, 3 and 6 month 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 24 month follow-up, the improvement of VA, defined as 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 only required a single injection, however, 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. The Corresponding Author has the right to grant on behalf of all authors and does grant on behalf of all authors, an exclusive licence (or non exclusive for government employees) on a worldwide basis to the BMJ Publishing Group Ltd to permit this article (if accepted) to be published in BJO and any other BMJPGL products and sublicences such use and exploit all subsidiary rights, as set out in our licence (http://group.bmj.com/products/journals/instructions-for-authors/licence-forms). Preliminary evidence from small, short term, single-center case series suggests that the use of intravitreal anti-VEGF in the treatment of RAP leads to improved outcomes. [12][13][14] The purpose of the current study was to determine longer-term visual and anatomic outcomes of anti-VEGF monotherapy in patients with RAP. NIH Public Access MethodsWe performed a retrospective review of medical records of all patients who underwent anti-VEGF treatment for AMD at the Doheny Eye Institute between August 1, 2005, and March 31, 2009‥ Patients were excluded if they had CNV secondary to conditions other than AMD if they received treatment other than anti-VEGF agents or had less than 6 months of followup.Patients were included if they had AMD with typical manifestations of RAP, including preretinal, intraretinal, and/or subretinal hemorrhages, intraretinal edema, and the presence of neovascularization in one of the three stages of the disorder as confirmed by fluorescein or indocyanine green angiography and optical coherence tomography (OCT). At baseline, and at each monthly follow-up visit, bes...

Two-year results of combined intravitreal anti-VEGF agents and photodynamic therapy for retinal angiomatous proliferation

“…The central retinal thickness (CRT), defined as the distance from the RPE to the inner limiting membrane at the center of the fovea, was measured manually at baseline, and 3, 6,9,12,15,18,21, and 24 months after treatment (months 3, 6, 9, 12, 15, 18, 21, and 24) using internal caliper software. FA was performed to determine the lesion type, location, CNV activity of the RAP lesions, and the greatest linear dimension (GLD).…”

“…Anti-VEGF monotherapy for RAP using intravitreal ranibizumab or bevacizumab requires repeated treatment [20,21]. We hypothesized that combined use of intravitreal anti-VEGF agents and PDT could be effective for RAP.…”

One-Year Outcomes Comparing Anti-VEGF Monotherapy and Combined Anti-VEGF+Photodynamic Therapy for Retinal Angiomatous Proliferation

“…As demonstrated by studies in literature, anti-VEGF treatment either as a monotherapy or in combination with PDT, has proved to be an efficient method of preserving visual acuity and providing anatomical success (10)(11)(12)(13)(14)(16)(17)(18)(19). Our study also presented results with preserved visual acuity and improved macular anatomy.…”

“…Anti-VEGF monotherapy can provide the necessary decrease in subretinal fluid, an active disease marker in clinical examination and optical coherence tomography (OCT), and also increase visual acuity (13). RAP lesions, however, might require more aggressive treatment protocols with PDT in clinical practice (14).…”

Neovascular Age-Related Macular Degeneration

“…Ranibizumab monotherapy patients gained +9.2 letters and PDT-V monotherapy patients +7.5 letters. Data from lower level clinical trials suggest that fibrovascular and serous pigment epithelium detachment, and retinal angiomatous proliferation lesions can be considered for treatment but might not respond as well as typical occult lesions [26,27]. …”