J Korean Ophthalmol Soc.  2013 Nov;54(11):1700-1707. 10.3341/jkos.2013.54.11.1700.

Twelve-Month Outcomes of Intravitreal Anti-Vascular Endothelial Growth Factor Therapy for Retinal Angiomatous Proliferation

• Kim DB
• Kim JH
• Jeong SH
• Lee TG
• Kim JW
• Kim CG
• Cho SW
• Lee DW
• Han JI

• KMID: 2217917
• DOI: http://doi.org/10.3341/jkos.2013.54.11.1700

Abstract

PURPOSE
To evaluate the 12-month outcomes of anti-vascular endothelial growth factor (VEGF) treatment for patients with retinal angiomatous proliferation (RAP).
METHODS
Retrospective review of medical records was performed for 33 patients (33 eyes) who were diagnosed with RAP. All patients were initially treated with three consecutive intravitreal anti-VEGF injections after diagnosis. Additional treatment was performed when the recurrence of exudation was noted. The best-corrected visual acuity (BCVA) was measured before the first injection and at 3, 6, and 12 months after the first injection. The value measured before the treatment was compared with those measured after treatment.
RESULTS
The patients received an average of 4.2 +/- 1.7 intravitreal anti-VEGF injections during the 12-month follow-up period. The logarithm of minimal angle of resolution (log MAR) values of BCVA before the first injection and at 3, 6, and 12 months after the first injections were 0.76 +/- 0.49, 0.55 +/- 0.35, 0.67 +/- 0.41, and 0.70 +/- 0.50, respectively. BCVA was significantly improved at 3 and 6 months (p < 0.001 and p = 0.037) compared to that measured before the first injection. However, there was no significant difference between BCVA before the first injection and 12 months after the first injection (p = 0.590). At 12 months of follow-up, 29 eyes (87.9%) showed stable (<2 log MAR lines of change) or improved (> or =2 log MAR lines of improvement) BCVA.
CONCLUSIONS
Anti-VEGF therapy was found to be beneficial in both normalizing macular thickness and in improving or maintaining visual acuity in the majority of patients with RAP.

Keyword

Anti-vascular endothelial growth factor; Clinical outcomes; Retinal angiomatous proliferation; Visual acuity

MeSH Terms

Diagnosis
Endothelial Growth Factors*
Follow-Up Studies
Humans
Medical Records
Recurrence
Retinaldehyde*
Retrospective Studies
Visual Acuity
Endothelial Growth Factors
Retinaldehyde

Figure

• 

  Figure 1. Central foveal thickness (double-head arrow) was defined as the vertical distance between internal limiting membrane and retinal pigment epithelium at foveal center based on optical coherence tomography image centered at the center of the fovea.

• 

  Figure 2. Fundus photography (A), indocyanine green angiography (B), and optical coherence tomography (C) images in an eye with retinal angiomatous proliferation. Arrow (B) on indocyanine green angiography image indicates retinal angiomatous proliferation lesion. Optical coherence tomography images showing macular microstructure before treatment (C1) and 3 months (C2), 8 months (C3), and 12 months (C4) after the first intravitreal anti-vascular endothelial growth factor injection. Recurrence of exudation was noted at 8 months following the first treatment. The best-corrected visual acuity measured before treatment was 20/40. The visual acuity was improved to 20/30 after three monthly injections, but deteriorated to 20/60 after the recurrence of exudation. At 12-month after the first treatment, the visual acuity was measured as 20/40.

• 

  Figure 3. Twelve-month changes in logarithm of minimal angle of resolution (log MAR) best-corrected visual acuity (A, BCVA) and central foveal thickness (B) in eyes with retinal angiomatous proliferation that were treated with anti-vascular growth factor mono-treatment, according to the follow-up period. Statistical analysis was performed using repeated measures analysis of variances.

• 

  Figure 4. (A-D) Baseline fundus photography (A), fluorescein angiography (B), indocyanine green angiography (C), and optical coherence tomography (D) findings of an eye with retinal angiomatous proliferation. (E-G) Twelve months after anti-vascular endothelial growth factor treatment, resolution of retinal hemorrhage (E) cessation of leakage (F) and resolution of intraretinal and subretinal fluid (G) was noted. The visual acuity was improved from 20/400 to 20/100.

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