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K. Hufendiek, G. E. Panagakis, H. Helbig, M.-A. Gamulescu; Ranibizumab (Lucentis®) Treatment in Patients With Retinal Angiomatous Proliferation - Long-Term Functional and Morphological Results. Invest. Ophthalmol. Vis. Sci. 2009;50(13):2359.
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Retinal angiomatous proliferation (RAP) is a variant of exudative age-related macular degeneration (AMD) with particularly bad prognosis. It is characterized by the proliferation of retinal capillaries, an associated contiguous telangiectatic response and extending process into the deep retina and subretinal space with development of retinal - choroidal anastomosis.The purpose of this work is to describe long-term functional and morphological outcome of patients treated with intravitreal ranibizumab.
Retrospective case series of nineteen eyes (10 left, 9 right) of 16 patients with RAP (2 male, 14 female, mean age 81years, range 71 to 91 years). After informed consent, all patients received initially three intravitreal ranibizumab injections (1.25mg/0,05ml) every 4 weeks. Follow-up ranged from 1 to 12 months after the third injection. Complete ophthalmologic examination including best-corrected visual acuity (BCVA), optical coherence tomography (OCT), fluorescein angiography (FA) and indocyanine green angiography (ICGA) in selected cases was performed. Best-corrected visual acuity (BCVA) was assessed using Snellen chart at 4 m and decimals were converted into logMAR (logarithm of the minimal angle of resolution) for statistical analysis. OCT measurements were performed and central macular thickness (CMT) was measured in µm. BCVA and CMT at baseline and each follow-up visit were compared using Student's t-test (P < 0.05 for 95% confidence level).
Triple intravitreal ranibizumab injections resulted in an improvement of BCVA during the first four months (logMAR 0.75 before treatment and 0.60 at month 4). Mean BCVA stabilised (logMAR 0.67) two to three months after the upload phase. Nine eyes (47.4%) needed retreatment at months 5 or 6, six of them were also retreated at month 9 or 12.CMT improved from 501 µm at baseline to 243 µm at month 2 then stabilised up to months 5 and 6 and reached statistical significance at these time-points (P=0.001, P=0.009, P=0.03, respectively). Both improvement of vision and reduction in CMT were maintained for at least 5 months after the upload phase in the majority of the eyes.
Patients with RAP might benefit from intravitreal ranibizumab treatments with stabilisation of BCVA over a longer period of time. Close follow-up should nevertheless be performed in this special subgroup.
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