Treatment of Retinal Angiomatous Proliferation with Intravitreal Anti-VEGF Drugs in Real Life Practice

Purpose: To evaluate the outcomes of intravitreal anti-VEGF in the treatment of retinal angiomatous proliferation (RAP) in real life practice.

Methods: The design of the study is a retrospective, interventional, multicentre, case series. All the charts of patients affected by RAP, regularly followed up and treated with anti-VEGF drugs over 12 months were examined. All the patients underwent, both at baseline and over the follow-up, a monthly complete ophthalmologic examination, including best corrected visual acuity (BCVA) on ETDRS charts, fluorescein angiography, indocyanine green angiography, and ocular coherence tomography. Both intravitreal injections of ranibizumab and bevacizumab were considered for the study. After an initial loading phase of three consecutive injections, further re-treatments were administered on the basis of the identification of persistence or recurrence of subretinal/intraretinal fluid. The main outcome measure was the change in the mean BCVA at the 12-month examination. Secondary outomes included the proportion of eyes gaining at least 3 ETDRS lines, the mean change in the central retinal thickness (CRT), and number of injections at the end of the follow-up.

Results: Sixty-one eyes of 61 patients were considered for the study. Overall, the mean BCVA changed from 0.62, to 0.47 LogMAR (p: 0.004) at the 12-month examination. Seventeen eyes (28%) gained at least 3 ETDRS lines, whereas no eye lost more than 3 ETDRS lines, over the follow-up. Mean CRT passed from 333μm to 222μm (p < 0.001). Twenty-three eyes (37%) showed serous pigment epithelium detachment (PED) at baseline, which was still visible in 10 eyes (16%) at the end of the follow-up. No difference in BCVA gain was registered comparing ranibizumab and bevacizumab. Pigment epithelium detachment was detectable in 5% and 30% of the eyes, treated with ranibizumab and bevacizumab, respectively (p: 0.01). Mean number of injection was 4 and 4.6 in ranibizumab and bevacizumab subgroups, respectively.

Conclusions: Intravitreal anti-VEGF therapy can ensure a visual function improvement in about one third of patients affected by RAP, who are treated in the common clinical practice. Ranibizumab treatment requires less injections and more frequently leads to a pigment epithelium detachment resolution.