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S.D. Solomon, S.B. Bressler, N.M. Bressler, TAP Study Group, VIP Study Group; Impact of Retinal Anastomosis to the Lesion (RAL, aka RAP) on Verteporfin Therapy in Classic CNV or Occult With No Classic CNV . Invest. Ophthalmol. Vis. Sci. 2005;46(13):335.
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Purpose: To assess the effect of the presence, at baseline, of retinal anastomosis to the lesion (RAL), also termed "retinal angiomatous proliferans" (RAP), on visual acuity outcomes in patients with either classic–containing lesions or occult with no classic lesions receiving verteporfin (Visudyne®, Novartis AG, Basel, Switzerland) therapy or placebo with sham treatment. Methods: Baseline stereoscopic color photographs and fluorescein angiograms from patients in the TAP Investigation (primarily lesions that contained classic CNV) and from the VIP Trial (limited to the occult with no classic lesions) were reviewed. Graders, masked to all outcomes, classified RAL as the presence of either a retinal vessel extended at a right angle from the inner retina towards the retinal pigment epithelium or an intraretinal hemorrhage overlying a retinal vessel anterior to CNV. Results: In TAP participants, 53 (13%) of 402 verteporfin–treated eyes and 23 (11%) of 207 placebo eyes had RAL at baseline. In the occult with no classic group from the VIP Trial, 17 (10%) of 166 verteporfin–treated patients had RAL at baseline, compared with 10 (11%) of 92 placebo recipients. In both classic–containing lesions and occult with no classic lesions, no influence of the presence of RAL on verteporfin treatment effect was identified by 24 months, as measured by mean visual acuity change, percentage of eyes with at least a 3– or 6–line vision loss, and eyes with visual acuity of 20/200 or worse. Conclusions: No interaction effect between the presence of RAL and verteporfin therapy on visual acuity outcomes in patients with either classic CNV or occult with no classic CNV was observed. Therefore there is no evidence to suggest that the presence or absence of RAL on fluorescein angiography should influence verteporfin therapy treatment recommendations.
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