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C. T. Cessna, S. N. Truong, D. G. Telander, S. S. Park, L. S. Morse; Treatment of Retinal Angiomatous Proliferation with Pan-VEGF A Inhibition. Invest. Ophthalmol. Vis. Sci. 2007;48(13):3372.
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To evaluate the efficacy of pan-VEGF A inhibition with either intravitreal bevacizumab or ranibizumab in the treatment of retinal angiomatous proliferation (RAP), a form of neovascular age-related macular degeneration.
Four patients with primary or recurrent RAP lesions diagnosed by fluorescein angiography and high-resolution Fourier-domain Optical Coherence Tomography (OCT) underwent intravitreal injection(s) of either bevacizumab 1.25mg or ranibizumab 0.5mg. Treatment was repeated if persistent cystoid macular edema or subretinal fluid was noted on Stratus OCT at monthly follow-up examinations. Two patients had newly diagnosed RAP lesions and two had recurrent RAP lesions that had been treated with photodynamic therapy and intravitreal kenalog at least 6 months earlier.
All patients showed an anatomical improvement on Stratus OCT and an improvement in BCVA with pan-VEGF A inhibition. At a mean follow-up of 3.5 months (range 2 to 6 months)(will have a range of 4 to 8 months with a 5.5 month mean follow-up), the mean BCVA improved from a baseline of 20/120 (logMar 0.8) to 20/60 (logMar 0.45) giving an average 3.5 line gain after an average of 2.25 intravitreal injections (range 1 to 4) of either bevacizumab or ranibizumab.
Various treatment modalities for RAP lesions secondary to AMD have been reported in the literature with variable results. Pan-VEGF A inhibition appears to be an effective treatment option for patients with primary or recurrent RAP lesions secondary to AMD even after failure with other treatment modalities.
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