The role of dynamic indocyanine green angiography in the diagnosis and treatment of retinal angiomatous proliferation

Bearelly, Srilaxmi; Espinosa‐Heidmann, Diego G.; Cousins, Scott W.

doi:10.1136/bjo.2007.118760

Cited by 14 publications

(8 citation statements)

References 13 publications

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“…RAP lesions are considered ‘high-flow,’22 with histopathological evidence of multiple growth factors, suggesting an ischaemic and inflammatory component to the development and progression of RAP 23. Anti-VEGF monotherapy targets only one component of RAP lesions with early improvement of vision.…”

Section: Discussionmentioning

confidence: 99%

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

Hemeida

Keane

Dustin

et al. 2009

British Journal of Ophthalmology

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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...

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Section: Discussionmentioning

confidence: 99%

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

Hemeida

Keane

Dustin

et al. 2009

British Journal of Ophthalmology

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“…Retinal angiomatous proliferation lesions are considered to be "high-flow" lesions that require multiple modalities with different mechanisms of action. 44 Another possible treatment of RAP may be a triple therapy using an anti-VEGF agent, PDT, and steroids because it is considered that the combination treatment may enhance the antiinflammatory and anti-VEGF effects associated with PDT than either agent alone with PDT.…”

Section: Groups 2 and 3 Had Only Stage II Lesions In Contrary Tomentioning

confidence: 99%

Long-Term Results of Intravitreal Ranibizumab, Intravitreal Ranibizumab With Photodynamic Therapy, and Intravitreal Triamcinolone With Photodynamic Therapy for the Treatment of Retinal Angiomatous Proliferation

Rouvas¹,

Chatziralli²,

Theodossiadis³

et al. 2012

Retina

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“…However the effect of focal laser treatment is short lived. The study by Bearelly et al 22 indicated that long-term stability (with complete absence of any leakage and improved visual outcome following salvage focal laser after recurrence) with PDT and triamcinolone was significantly longer than with focal laser as primary therapy. This effect could be due to either incomplete treatment with previous focal laser or early treatment for reperfusion leading to a prolonged effect.…”

Section: Laser Photocoagulationmentioning

confidence: 99%

Current treatment options for retinal angiomatous proliferans (RAP)

Gupta

Jyothi

Sivaprasad

2009

British Journal of Ophthalmology

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Retinal angiomatous proliferation (RAP) accounts for 12-15% of all patients with neovascular age-related macular degeneration (NV-AMD). However, this subtype is often excluded from clinical trials aimed at assessing the efficacy of various treatment options for NV-AMD. Thus, there are no established protocols for the management of RAP. This review of current literature on RAP compares the outcomes of various treatment options for this condition and highlights the lack of clinical trials and paucity of long-term data on this relatively common condition.

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The role of dynamic indocyanine green angiography in the diagnosis and treatment of retinal angiomatous proliferation

Cited by 14 publications

References 13 publications

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

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

Long-Term Results of Intravitreal Ranibizumab, Intravitreal Ranibizumab With Photodynamic Therapy, and Intravitreal Triamcinolone With Photodynamic Therapy for the Treatment of Retinal Angiomatous Proliferation

Current treatment options for retinal angiomatous proliferans (RAP)

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