Treatment of RAP lesions in clinical practice: a 5-year follow-up

Abstract

Purpose : Given its distinctive features and intrinsic fierceness, RAP lesions constitute a significant challenge in daily clinical practice. Data on the long-term treatment effectiveness is scarce, and the longest reported period of follow-up is of 3 years. The purpose of this study was to evaluate de 5-year efficacy of IV ranibizumab in the treatment of RAP lesions, and to identify prognostic-related factors using multimodal retinal imaging.

Methods : Cross-sectional study including patients with confirmed diagnosis of RAP and 60 months of follow-up after the first intravitreal injection of ranibizumab. Treatment was administered according to a PRN regimen, and in 26 eyes, baseline photodynamic therapy (PDT) was instituted. Initial evaluation involved a complete ophthalmological evaluation, complemented with multimodal retinal imaging. Classification of RAP stage at diagnosis was performed by a senior retina specialist. Improvement and deterioration of visual acuity (VA) were defined as an increase or decrease of ≥5 ETDRS letters from baseline. A stable VA encompassed any values between these limits.

Results : Forty-seven eyes from 41 consecutive patients were included. Mean age at diagnosis was 77.2±6.3 years, and mean initial VA was of 53.7±16.0 ETDRS letters. All eyes were cross-sectionally evaluated at 60 months of follow-up. An increase from baseline VA was noted in 13 individuals (27.7%), while VA deterioration occurred in 27 (57.4%). Stabilization was observed in 7 (14.9%) eyes. The mean number of IV ranibizumab injections was 9.6±5.5. The concomitant use of PDT did not add benefits vs. IV ranibizumab monotherapy in what concerns the visual prognosis (p=0.986) or the development of geographic atrophy (p=0.551). Subretinal fluid (SRF) at presentation positively correlated with favorable visual outcomes (p=0.025).

Conclusions : RAP lesions constitute a distinct neovascular phenotype of AMD. This study combines the largest population of RAP eyes with the longest reported follow-up in a clinical setting. After 5 years of follow-up, the instituted treatment allowed for an improvement or stabilization of VA in 42.6% (n=20) of our population. Baseline subretinal fluid may play an important role in the prognosis of RAP.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.