Intravitreal ranibizumab for the treatment of retinal angiomatous proliferation

Abstract

Retinal angiomatous proliferations (RAP) are asubgroup of exsudative or "wet" age-related macular degeneration (wAMD) with devastating reduction of visual acuity in later stages. Intravitreal ranibizumab provides good therapy, but is considered to be less effective than in other choroidal neovascularizations (CNV). We investigated the efficacy of ranibizumab in late-stage IIIRAP with retinochoroidal anastomosis compared to the outcome of other CNV lesions. The data of all patients with wAMD treated with ranibizumab were retrospectively analyzed. Patients were divided into groups depending on the lesion type into RAP (identified and selected clinically, proven by fluorescein angiography) and CNV lesions (identified by fluorescein angiography only) named occult, minimally and predominantly classic groups. The best-corrected visual acuity (BCVA) was obtained before (at the timepoint "diagnosis"), during (1st, 2nd, and 3rd injection), and after upload ("1st control"). Before first injection, visual acuity decreased in all groups (0.73to 0.78logMAR for all CNV, 0.95to 1.02logMAR for RAP). During upload there was no further decline in visual acuity but no improvement as well up to the 1st control visit in the RAP group (1.02to 1.03logMAR), but astatistically significant increase in all other groups (0.78to 0.67logMAR). Treatment of late-stage IIIRAP with ranibizumab is effective. Stabiliziation of visual acuity can be achieved, but-in contrast to other forms of CNV lesions-no further improvement. Therefore, patients with this special form need to be identified and treated as early as possible.