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Long-term visual and anatomical outcomes following anti-VEGF monotherapy for retinal angiomatous proliferation
  1. Tarek S Hemeida1,
  2. Pearse A Keane1,
  3. Laurie Dustin2,
  4. Srinivas R Sadda1,
  5. Amani A Fawzi1
  1. 1Doheny Eye Institute, Department of Ophthalmology, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
  2. 2Statistical Consultation and Research Center, Department of Preventative Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
  1. Correspondence to Dr Amani A Fawzi, Doheny Eye Institute, 1450 San Pablo Street, DEI 3614, Los Angeles, CA 90033, USA; afawzi{at}


Aim To study the long-term visual and anatomical outcomes of antivascular endothelial growth factor (VEGF) monotherapy for the treatment of patients with retinal angiomatous proliferation (RAP).

Methods Retrospective review of patients who were diagnosed as having AMD and RAP lesions, and who received anti-VEGF injections as the only mode of therapy.

Results 20 eyes (15 patients; nine women, six men) with RAP lesions treated by anti-VEGF were encountered. The mean patient age was 85.8 years (SD±4.54). Nine eyes were treated with intravitreal ranibizumab alone, eight eyes were treated with bevacizumab alone, and three eyes received both drugs. At 1, 3 and 6 months' follow-up the median VA had improved from baseline (20/72) to 20/52 (range: 20/25 to 20/400), 20/45 (range 20/20 to 20/400), and 20/56 (range 20/20 to 20/400), respectively, (p>0.001, p=0.001 and p=0.05, respectively). At the 24-month follow-up, the improvement in VA, defined as a halving of the visual angle, occurred in 37.5% of the cases.

Conclusions Anti-VEGF monotherapy represents a useful treatment option for RAP, with stable or improved visual acuity in 62.5% of patients at 2 years. 25% of eyes required only a single injection, but in most cases (75%) repeated treatments were required, highlighting the need for long term follow-up. Although, in this small study, the results for visual improvement were not statistically significant beyond 3 months, our findings warrant further large-scale investigation.

  • Age-related macular degeneration
  • bevacizumab
  • long term follow-up
  • ranibizumab
  • retinal angiomatous proliferation
  • retina

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  • Funding AAF receives grant support from Optovue, Inc and Reichert, unrelated to the articles subject matter. SRS is coinventor of Doheny intellectual property related to optical coherence tomography that has been licensed by Topcon Medical Systems and has served as a consultant for Heidelberg Engineering. However, it is not related to the article's subject matter. Supported in part by National Institutes of Health Grant EY03040 and National Eye Institute Grant R01 EY014375.

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval Ethics approval was provided by the institutional review board of the University of Southern California.

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

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