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Type 3 neovascularisation (retinal angiomatous proliferation) treated with antivascular endothelial growth factor: real-world outcomes at 24 months
  1. Alessandro Invernizzi1,2,
  2. Kelvin Teo2,3,
  3. Vuong Nguyen2,
  4. Mark Daniell4,
  5. David Squirrell5,
  6. Daniel Barthelmes2,6,
  7. Mark C Gillies2
  1. 1 Eye Clinic, Department of Biomedical and Clinical Science “Luigi Sacco”, Luigi Sacco Hospital, University of Milan, Milan, Italy
  2. 2 Save Sight Institute, University of Sydney, Sydney, New South Wales, Australia
  3. 3 Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
  4. 4 Centre For Eye Research Australia, Melbourne, Victoria, Australia
  5. 5 Greenlane Clinical Centre, University of Auckland, Auckland, New Zealand
  6. 6 University Hospital Zurich, University of Zurich, Zurich, Switzerland
  1. Correspondence to Dr Alessandro Invernizzi, Eye Clinic, Department of Biomedical and Clinical Science “Luigi Sacco”, Luigi Sacco Hospital, University of Milan, Milan 20157, Italy; alessandro.invernizzi{at}


Aims To compare 24 months outcomes of eyes with retinal angiomatous proliferations (RAPs) treated with antivascular endothelial growth factor (anti-VEGF) with a group of controls diagnosed with other neovascular age-related macular degeneration (nAMD) subtypes in a real-world setting.

Methods Treatment-naïve nAMD eyes that commenced anti-VEGF between January 2006 and November 2015 were identified from a registry of nAMD treatment outcomes. Cases were defined as eyes diagnosed with RAP. Three controls per case were selected among nAMD eyes with non-RAP lesions and matched on baseline visual acuity (VA), year of treatment initiation, anti-VEGF agent first injected and follow-up. Baseline VA was compared with 12 and 24 months VA. Change in VA, number of injections received, proportion of visits with active nAMD and time to first inactivation were compared between RAPs and controls.

Results 157 RAPs and 469 controls were included. Baseline VA (mean (SD)) increased at 12 months (61.4 (15.5) vs 68.7 (14.7) letters, p<0.001) and remained higher (66.6 (17.3) letters) at 24 months (p<0.001) in RAPs. The change from baseline VA (mean(95% CI)) was significantly higher in RAPs than in controls at 12 months (7.3 (5.4 to 9.1) vs 4.1 (2.8 to 5.4) letters, p=0.01) and at 24 months (5.1 (2.8 to 7.3) vs 2.5 (1 to 4) letters, p=0.056). Both groups received a median of 13 injections. RAPs inactivated earlier and were less active than controls (both p<0.001).

Conclusions RAPs responded well to anti-VEGF, with a significant improvement in VA persisting at 24 months. RAPs had better visual outcomes than controls at 12 and 24 months, tended to inactivate earlier and were less active throughout 2 years follow-up.

  • retinal angiomatous proliferation
  • type 3 CNV
  • choroidal neovascularisation
  • age-related macular degeneration
  • anti-VEGF
  • visual outcomes

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  • Collaborators Fight Retinal Blindness! investigators: Auckland District Health Board, New Zealand (Dr D Squirrell); Armadale Eye Clinic , Victoria (Dr A Cohn); Bundaberg Eye Clinic, Queensland (Dr I McLean); Cairns Eye Surgery, Queensland (Dr A Field); Canberra Hospital, Australian Capital Territory (Dr C Dayajeewa, Dr J Wells, Dr R Essex); Care Foresight, New South Wales (Dr A Dunlop); Central Coast Eye Specialist, New South Wales (Dr S Young); Centre for Eye Research Australia, Victoria (Professor R Guymer); Coastwide Eye Surgery, New South Wales (Dr R Ferrier); Crest Eye Associates, New Zealand (Dr J Ah-Chan); Doncaster Eye Center, Victoria (Dr L Chow); Dr Clarks Practice, New South Wales (Dr G Clark); Dr Nadia Wittles Practice, South Australia (Dr N Wittles); Dr. Phillip Windle, Queensland (Dr P Windle); Eye Associates, New South Wales (Dr M Gillies, Dr A Hunt); Eye Surgeons Miranda, New South Wales (Dr A Hunt); Eyemedics, South Australia (Dr K Billings, Dr J Chen, Dr S Lake, Dr J Landers, Dr M Perks, Dr R Phillips, Dr N Saha); Gladesville Eye Specialists, New South Wales (Dr S Young); Hornsby Eye Specialists, New South Wales (Dr S Lal); Les Manning Practice, Queensland (Dr L Manning); Lions Eye Institute, Western Australia (Professor F Chen, Professor I McAllister); Marsden Eye Specialists, New South Wales (Dr J Arnold); Midwest Ophthalmology, New South Wales (Dr K Tang); Nepean Valley Eye Surgeons, New South Wales (Dr G Banerjee); Port Macquarie Eye Centre, New South Wales (Dr J Game, Dr C Thompson); Retina Associates, New South Wales (Dr S Fraser-Bell, Professor A Hunyor, Dr C Younan); Retina Consultants, New South Wales (Dr S Young); Retina Specialists, New Zealand (Dr R Barnes, Dr A Vincent); Singapore National Eye Centre , Singapore (Dr G Cheung); Southeastern Eye Care, New South Wales (Dr B Swamy); Specialist Eye Group, Victoria (Dr L Chow, Dr A Cohn); Strathfield Retina Clinic, New South Wales (Dr C Lim); Sydney Eye Hospital, New South Wales; Tamworth Eye Centre, New South Wales (Dr P Hinchcliffe); University Hospital Zurich, Switzerland (Dr D Barthelmes); Victoria Parade Eye Consultants, Victoria (Dr M Daniell, Professor R Guymer, Dr A Harper, Dr J O’Day).

  • Contributors AI, MG: were involved in the conception and design of the study. AI, KT, MG, MD, DS, DB: were involved in the data collection. AI, MG, VN, KT: were involved in the analysis and Interpretation of the data. AI: wrote the first draft of the manuscript. All authors were involved in the critical revision and final approval of the article.

  • Funding The Fight Retinal Blindness! project is supported by a grant from the Macular Disease Foundation Australia and unrestricted educational grants from Bayer and Novartis.

  • Competing interests Gillies and Barthelmes are inventors of the software used to collect the data for this analysis.

  • Patient consent Not required.

  • Ethics approval Institutional ethics approval was obtained from the Human Research Ethics Committees of the University of Sydney, the Royal Victorian Eye and Ear Hospital, the Royal Australian and New Zealand College of Ophthalmologists, the University Hospital, Zurich and the Singhealth, Singapore.

  • Provenance and peer review Not commissioned; externally peer reviewed.