One year results of intravitreal ranibizumab monotherapy for retinal angiomatous proliferation: a comparative analysis based on disease stages

Abstract

BackgroundRetinal angiomatous proliferation (RAP) has been known as a variant of exudative age-related macular degeneration (AMD) with a unfavorable prognosis. To evaluate the effect of ranibizumab administered initially as three loading doses for patients with various stages of RAP.MethodsA retrospective chart review of 40 patients (41 eyes) with RAP was conducted. The study divided patients into three groups of Group I (8 eyes in stage I), Group II (17eyes in stage II), and Group III (16 eyes in stage III). All patients received three initial monthly intravitreal injections (0.5 mg) of ranibizumab and were monitored monthly for 12 months. Reinjection of ranibizumab after three initial monthly doses was administered on as-needed basis. The main outcome measures were the change in the mean of best-corrected Snellen visual acuity (BCVA) and central macular thickness (CMT), and the total number of injections received during the 12 months.ResultsThe mean change in BCVA at 12 months was-0.286,-0.165, and-0.151 (logMAR) in Group I, II, and III, respectively. CMT was also reduced by a mean of 32.72 ± 56.75, 57.45 ± 56.48 and 148.37 ± 98.59 μm. The mean number of injections in Group I was significant lower than those in Group II and III (P < 0.001, P < 0.001, and P = 0.15 for Group I versus Group II, Group I versus Group III, and Group II versus Group III, respectively).ConclusionsThe 12-month follow-up outcomes suggest that three consecutive loading doses of intravitreal ranibizumab is an effective treatment on early stage (stage I) of RAP. Patients in stage I showed a significantly lower recurrence rate than patients in later stages.

Three-Year Outcomes of Intravitreal Aflibercept Injections for Retinal Angiomatous Proliferation According to Disease Stage

“…The stage of RAP has been proposed as a key factor in the effectiveness of treatment and prognosis. Early-stage lesions (stage I) seem to be associated with better visual and anatomical outcomes, whereas late-stage diseases (stage III) were reported to exhibit limited improvement with treatment by intravitreal injections of ranibizumab and bevacizumab [ 8 , 12 , 17 – 21 ]. In the current study, the baseline BCVA and CRT were similar among different stages.…”

“…During the 3-year study period, a significant decrease in BCVA was noted in eyes with stage II RAP at the second year, whereas eyes with stage I or stage III RAP could achieve stabilization in BCVA. Park and Roh [ 21 ] reported that three consecutive loading doses of intravitreally administered ranibizumab was an effective treatment for patients with stage I RAP within 1 year, resulting in a significantly lower recurrence rate than in patients in later stages. By contrast, our results indicated that an average of 5.3 ± 1.72 injections in the first year followed by a total of 10.4 ± 3.85 injections were required for patients with stage I RAP to maintain stabilized BCVA after 3 years.…”

“…However, whether visual and anatomical outcomes of RAP lesions treated with anti-VEGF are comparable to those of non-RAP CNV lesions remains controversial [ 1 ]. Furthermore, the influence of RAP stage on treatment outcomes has been highlighted in many investigations, which demonstrated a trend of better prognosis when early-stage RAP is treated relative to trends when more advanced lesions are treated [ 8 , 12 , 17 – 21 ]. Nevertheless, differences in the anti-VEGF agents used and re-treatment criteria in studies may have affected the reported outcomes, and the RAP lesion stage was often not clearly detailed [ 1 ].…”

Charakterisierung der Subtypen makulärer Neovaskularisation bei altersbedingter Makuladegeneration zur Optimierung von Behandlungsergebnissen

“…Eine Typ-3-MNV war nach 2 Jahren öfter inaktiv, obwohl die mediane Anzahl an Injektionen ähnlich denen in der Gruppe mit Typ-1- und Typ-2-MNV war [42]. Wenn die Läsion jedoch in einem früheren Stadium behandelt wurde, verringerte sich die Gesamtanzahl der nach 1 Jahr benötigten Injektionen [49]. Darüber hinaus waren die Ergebnisse bezüglich der Sehschärfe in Stadium 3 schlechter als in Stadium 2 und unerwünschte Ereignisse, die zu einer abrupten Visusverschlechterung führen können, entwickelten sich erst in Stadium 3 [50].…”

Sonderformen choroidaler Neovaskularisationsmembranen

“…in 29 % (IVRI) der Patienten. Auch Park und Mitarbeiter fanden insbesondere im Stadium 1 ein gutes Ansprechen auf Ranibizumab[81]. Tsaousis[82] und Matsumoto[83] publizierten ein entsprechendes Ansprechen unter Aflibercept-IVOM, Letzterer auch unter einem Treat-and-Extend-Regime (im Mittel 7,2 Injektionen im 1.…”