Retinal Angiomatous Proliferation

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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“…Combined therapy of bevacizumab with PDT showed resolution in 6 out of 7 patients (Fig. 1, 3-5; online suppl. Fig.…”

Section: Discussionmentioning

confidence: 99%

“…RAP represents approximately 15–30% of newly diagnosed patients with exudative AMD [2-4]. The prognosis of RAP is poor with typical rapid progression and, without therapy, ending in a disciform scar and atrophy [5]. …”

Section: Introductionmentioning

confidence: 99%

Treatment Effects in Retinal Angiomatous Proliferation Imaged with OCT Angiography

et al. 2018

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“…RAP is considered a distinct form of nAMD with high vasogenic potential and rapid progression to advanced stages with, finally, poor visual outcome, especially in cases of inadequate treatment or delayed diagnosis [5]. Early detection and immediate treatment are crucial parameters for the achievement of a favorable functional outcome [20].…”

Section: Discussionmentioning

confidence: 99%

“…RAP is a highly vasogenic and rapidly progressing form of neovascularization with generally poor visual prognosis [5]. Moreover, RAP appears to be resistant to therapeutic strategies such as conventional laser photocoagulation [6] and photodynamic therapy (PDT) [7].…”

Section: Introductionmentioning

confidence: 99%

Long-Term Results of Combination Treatment with Single-Dose Ranibizumab plus Photodynamic Therapy for Retinal Angiomatous Proliferation

Malamos¹,

Tservakis²,

Kanakis³

et al. 2018

Ophthalmologica

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Purpose: To present functional and anatomic outcomes of combination therapy with ranibizumab and photodynamic therapy (PDT) in a series of retinal angiomatous proliferation (RAP) cases. Methods: A total of 17 eyes of 17 patients with RAP were included. Thirteen eyes were treatment naïve and 4 were already on ranibizumab monotherapy. Combined treatment with single-dose ranibizumab and PDT was performed on all treatment-naïve cases. Follow-up was performed every month for 6–38 months, using optical coherence tomography and indocyanine green angiography when necessary. Results: Overall, 6 out of 7 treatment-naïve cases with stage I or II disease manifested complete angiographic resolution of the hot spot with a single injection of ranibizumab plus PDT. In stage III disease, 7 out of 10 eyes showed persistent leakage immediately after the combined treatment. The rate of hot spot occlusion was found to correlate with the stage of disease (p = 0.05). There was a significant improvement in posttreatment BCVA for all patients regardless of disease stage (p = 0.02), which was more evident in the earlier stages. Improvement was also greater for treatment-naïve patients (p = 0.03). The posttreatment improvement in BCVA was strongly correlated with hot spot occlusion (p < 0.001). Conclusions: Single-dose modified anti-VEGF treatment in combination with PDT may provide long-term regression at the initial stages of RAP.

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“…While several treatment approaches proved unsuccessful in the past [13,14,15,16,17], the blockage of vascular endothelium growth factor (VEGF) has substantially changed the prognosis of this condition. 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].…”

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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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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Retinal Angiomatous Proliferation

Cited by 72 publications

References 20 publications

Treatment Effects in Retinal Angiomatous Proliferation Imaged with OCT Angiography

Treatment Effects in Retinal Angiomatous Proliferation Imaged with OCT Angiography

Long-Term Results of Combination Treatment with Single-Dose Ranibizumab plus Photodynamic Therapy for Retinal Angiomatous Proliferation

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

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