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C. Alovisi, C. M. Eandi, M. Sferra, F. M. Grignolo; Long Term Treatment of Retinal Angiomatous Proliferation With Intravitreal Injection of Ranibizumab. Invest. Ophthalmol. Vis. Sci. 2009;50(13):2357.
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To report the safety and effectiveness of intravitreal injection of ranibizumab for the treatment of retinal angiomatous proliferation (RAP).
In this prospective consecutive series, patients with RAP stage II and III were included. Complete ocular examination, visual acuity with ETDRS chart, digital fluorescein angiography (FA), indocyanine green angiography (ICGA), and optical coherence tomography (OCT) were performed at baseline and at standard monthly based intervals thereafter. In all eyes, intravitreal injection of 0.05 mg/ml of ranibizumab was performed. Monthly re-treatment was allowed when angiography or OCT examination revealed a recurrent lesion or vision decreased > 5 letters. Follow-up was at least 6 months.
19 eyes of 14 patients with RAP stage II and III were enrolled and followed for at least 6 months. Mean age was 69 years (range 58 to 77 years). These patients were all classified as occult or minimally classic choroidal neovascularization (CNV) with FA, while ICGA revealed a RAP lesion. At the 6 month visit, improvement of vision (≥ 3 lines) was achieved in 4 eyes (21%). 12 eyes had stable vision (63%), and 3 eyes (16%) experienced a decrease in vision (≥ 3 lines). Repeat treatment was required in 15 eyes (79%) on an average of 3 treatments in 6 months. Nine of 19 eyes (47%) were followed for 1 year. At the 12 month visit, visual acuity improved in 3 of 9 eyes (33%), and was stable in 6 of 9 eyes (67%). Mean number of intravitreal injection was 4.5 at 1 year.
This study indicates that stabilization or improvement of vision is achieved in the majority of eyes (84%) with RAP 6 months after intravitreal injection of bevacizumab. However, retreatments are necessary in order to control the recurrences and stabilize the vision. These outcomes compare favorably to previous reports on treatment of RAP. Further studies with longer follow-up are warranted to investigate the long-term efficacy in these conditions.
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