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F. Liu, Y. Liu, M. Khuthaila, T. Jayasundera, I. J. Galic, J. C. Chen; Different Treatment Options of Retinal Angiomatous Proliferation. Invest. Ophthalmol. Vis. Sci. 2010;51(13):4534.
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To determine the outcome of different treatment modalities in eyes with retinal angiomatous proliferation (RAP).
A computer database search for the diagnosis of RAP with fluorescein angiographic and OCT documentations performed between 2003 and 2009 was done. We performed retrospective chart review on these patients. Only patients with more than six months of follow up information were included. Information including initial visual acuity (VA), fundus biomicroscopy, fluorescein angiogram and optical coherence tomography findings, treatment methods and response, both at initial visit and on follow up were recorded.
A total of 45 patients (56 eyes) were included. The male-female ratio was 1:2. The average age was 81years. The follow up time ranged from six months to two years. Stage 3 RAP was found in 37 eyes, with an average initial VA of 0.27; stage 2 in 13 eyes, with an average VA of 0.21; and six eyes had stage 1 RAP with an initial VA of 0.42. At six months follow up, the average VA was 0.29, 0.27 and 0.40 respectively. Over the duration of the study period, the treatment of choice ranged from PDT combined with laser and/or intravitreal injections of triamcinolone (PDT-combo), to monthly injections of anti-VEGF agent alone (IVB-IVR). The average initial VA of the PDT-combo group was 0.25; at six-month follow up, the average VA was 0.36. The average initial VA of the IVB-IVR group was 0.35; VA at six month was 0.38. VA improved in 48% of PDT combo group, remained the same in 35%, and decreased in 17% at six-month follow up. In the IVB-IVR group, the VA improved in 57%, remained the same in 14% and decreased in 29%. At two year follow up, the final acuity was 0.23 in the PDT combo group and 0.27 in the IVB-IVR group.
RAP is found mainly in elderly female patients. Most patients respond well to different modalities of treatment initially. PDT combined with laser and intravitreal triamcinolone seem to yield better outcome in the first six months with more patients having either improved or stable vision compared to the group receiving initial monthly anti-VEGF therapy only. Over the long run, there is a gradual loss of vision due to recurrent disease despite repeated treatments.
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