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Evripidis Sykakis, Michail Malandrakis, Sreekumari Pushpoth, Andrew Browning, Rajen Gupta, James Talks; Intravitreal Ranibizumab and Intravitreal Triamcinolone with PDT for the Treatment of Retinal Angiomatous Proliferation. A retrospective Comparative Study. Invest. Ophthalmol. Vis. Sci. 2011;52(14):1660.
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© ARVO (1962-2015); The Authors (2016-present)
Retinal angiomatous proliferation (RAP) is a distinct form of neovascular age-related macular degeneration (ARMD), characterised by rapid deterioration of vision and poor prognosis. Many different approaches regarding the management of RAP lesions have been employed over the last few years. The aim of this study was to compare the 1 year functional outcome of intravitreal Ranibizumab and IVTA plus PDT in the treatment of RAP.
Retrospective review of patients diagnosed with RAP and had undergone treatment with PDT plus IVTA (4 mg) or Ranibizumab (0.5mg). Case notes were evaluated recording: LogMAR best corrected visual acuity (BCVA) pre treatment, 6 and 12 months post treatment, total number of injections, PDT and complications.
A total of 91 eyes of 79 patients diagnosed with RAP were treated. All patients had completed at least 1 year follow up. Out of the 91 eyes, 25 were treated with PDT plus IVTA (group 1) and 66 were treated with Ranibizumab (group 2). In group 1, on an average 1.84± 1.21 (mean ±SD) PDT sessions were performed and 1.45±0.88 IVTA injections were given, while in group 2, 6.39±2.89 Ranibizumab injection were given. Mean BCVA at initial examination in group 1 was 56.68±14.28 letters while at 6 months it was 54.95±16.07 and at 12 months it was 56.40±14.93. In group 2 the respective mean BCVAs were 52.45±12.35, 60.68±13.75 and 59.24±14.49. In group 1 patients lost an average of 1.73 letters at 6 months (p>0.05) and 0.28 letters at 12 months (p>0.05) compared to group 2 were patients gained 8.23 letters at 6 (p<0.001) and 6.79 at 12 months (p=0.001). Mean cumulative probability of success at 12 months (defined as ±15 letters of baseline BCVA) was 100% in group 1 and 93% in group 2. Complications in group 1 included steroid induced cataract, ocular hypertention and glaucoma and in group 2, secondary glaucoma and ocular hypertention. The complication rate in group 1 was 16% while in group 2 was 6%.
Both treatment modalities in our cohort stabilised visual acuity in this normally progressive subtype of neovascular ARMD but only in the Ranibizumab group there was statistically significant mild improvement in logMAR visual acuity. Additionally, in the group treated with IVTA and PDT significantly less treatment sessions were needed.
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