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...