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T. S. Hemeida, P. A. Keane, S. R. Sadda, A. A. Fawzi; Long Term Visual and Anatomic Outcomes Following Anti-VEGF Monotherapy for Retinal Angiomatous Proliferation. Invest. Ophthalmol. Vis. Sci. 2009;50(13):6203.
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To study the long-term visual and anatomic outcomes of anti-vascular endothelial growth factor (VEGF) monotherapy for the treatment of patients with retinal angiomatous proliferation (RAP).
17 eyes (15 patients; 6 men, 9 women), demonstrating the characteristic features of RAP, were retrospectively collected. All patients were treated exclusively with intravitreal anti-VEGF therapies, and a minimum of six months follow-up after initial treatment was required for inclusion. At baseline, and at each follow-up visit, best-corrected Snellen visual acuity (VA), and central retinal thickness as determined by optical coherence tomography (OCT), were recorded for each subject. Fluorescein angiography was performed at baseline and as required on subsequent visits. The need for retreatment at follow-up was determined principally by OCT-related criteria e.g. persistence/reoccurrence of intraretinal/subretinal fluid accumulation, or increases in retinal thickness.
Mean patient age was 86 years (range 77-92 years). Mean patient follow-up was 19 months (range 6-35 months). 7 eyes were treated exclusively with intravitreal ranibizumab, 7 eyes were treated exclusively with bevacizumab, and 3 eyes received both ranibizumab and bevacizumab during the course of their follow-up. 15/17 eyes (88%) required repeated injections throughout the follow-up period. VA improved one line or more in 9 eyes (53%; mean baseline VA 20/200, mean final VA 20/70; mean follow-up 17.6 months) accompanied by mean decrease in central foveal thickness of 155 µm. 3 eyes( 18%) maintained stable VA ( mean VA 20/50; mean follow-up 12 months), which was associated with a 56 µm mean decrease in central foveal thickness. In 3 eyes (18%), there was a decrease of VA of one or more lines (mean baseline VA 20/70, mean final VA 20/100; mean follow-up 31 months). 2/17 eyes (12%) required only a single treatment with intravitreal bevacizumab. One eye had 2 lines improvement of vision (baseline VA 20/200, final VA 20/70) associated with 334 µm decrease in central foveal thickness (no further injections required during follow-up of 25 months).The other eye had stable vision (VA 20/60; follow-up 6 months).
The results from our study suggest that anti-VEGF monotherapy represents a useful treatment option for RAP, with stable or improved visual acuity in 82.35% of patients. In most cases (88%) repeated treatments were required to improve or maintain visual acuity. Long-term follow-up is recommended as patients with RAP lesions may require retreatment.
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