Type 3 Neovascularization

Abstract

The neovascularization in RAP may originate not only from deep retinal capillaries but also from the choroid. We therefore propose the more descriptive term "Type 3 neovascularization" for this entity to emphasize the intraretinal location of the vascular complex and distinguish this type from the two types of neovascularization previously described by J. Donald Gass in his classic text.

Intravitreal ranibizumab (Lucentis®) in the treatment of retinal angiomatous proliferation (RAP)

“…It has been hypothesized that RAP lesions might respond more rapidly to intravitreal anti-VEGF therapies [1]. This is in accordance with our results, considering that 81.5% of the total visual improvement and 85% of the total CMT reduction occurred during the first post-operative month, after one intravitreal injection of ranibizumab.…”

“…Freund et al [1] reported rapid resolution of the intraretinal edema, hemorrhage, and neovascular lesion of three patients with RAP lesions treated with a single injection of intravitreal ranibizumab.…”

“…RAP lesions have been identified as a poor prognostic factor, and most of the older established treatments did not seem to alter the natural history of these eyes significantly [1], in contrast to typical exudative AMD [5]. Various treatment modalities have been used in the treatment of RAP, including direct laser photocoagulation, transpupillary thermotherapy, surgical removal, and photodynamic therapy (PDT) with verteporfin (Visudyne; Novartis Pharma AG, Basel, Switzerland) with or without concomitant intravitreal triamcinolone [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22].…”

“…Retinal angiomatous proliferation (RAP) is a distinct variant of neovascular age-related macular degeneration (AMD) in which, principally, new vessels proliferate within the neurosensory retina itself (CNV) [1][2][3]. The typical clinical presentation of RAP appears to be unique compared with more common forms of neovascular AMD, representing 12% to 15% of newly diagnosed patients with neovascular AMD [3,4].…”

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

“…To the best of our best knowledge, there is only one study of ranibizumab as single-dose monotherapy. This study included only early cases of RAP (stage I and II), and authors reported either complete response or spontaneous resolution without treatment [32]. However, long-term data confirming the sustainability of these positive initial results are not available.…”