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Carolin Perz, Julia Bockmaier, Nikolaus Feucht, Chris Patrick Lohmann, Mathias Maier; Anti-VEGF Monotherapy for Retinal Angiomatous Proliferation. Invest. Ophthalmol. Vis. Sci. 2011;52(14):3529.
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To report the efficacy of intravitreal anti-vascular endothelial growth factor (VEGF) therapy for the treatment of retinal angiomatous proliferation (RAP) in patients with neovascular age-related macular degeneration.
Retrospective review of 33 eyes of 33 patients with RAP stage II-III disease treated with intravitreal injections of 0.5mg ranibizumab. The injections were applied at monthly intervals for a 3 months period (upload phase). Criteria for retreatment (maintenance phase) were visual loss, new bleeding on fundoscopy, residual fluid or increase in central retinal thickness (CRT) on spectral domain optical coherence tomography (OCT) as well as persistent leakage on fluorescein angiography (FA). OCT and FA were performed every 4 months (baseline, month 4, month 8). Main outcome measures were best corrected visual acuity (BCVA) and anatomical changes on OCT and FA over time.
All Patients completed the 4 months follow-up, 82% the 8 month follow-up. The mean baseline BCVA was logMAR 0.71, increased to logMAR 0.67 after the upload phase and to logMAR 0.64 at month 8. After 8 months BCVA increased by >= 1 line (decimal VA) in 44% of patients, remained stable in 22% and decreased by >= 1 line in 33%. Mean CRT decreased by 90 µm at month 4 and by 66 µm at month 8. Poor visual outcome was statistically significant related to poor baseline BCVA (p=0.037) and correlated with higher CRT values on OCT. After the upload phase, in 67% of patients OCT and FA revealed still active disease requiring further intravitreal injections. Mean number of reinjections was 2.27 at 8 months follow-up.
Anti-VEGF therapy with intravitreal application of ranibizumab represents an effective treatment option for RAP stage II-III lesions with a functional and anatomical improvement. In most cases repeated treatment is required underlining the need for long-term follow-up.
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