Purpose To report the results of 3-year follow-up examinations after intravitreal ranibizumab (IVR) injection for the treatment of retinal angiomatous proliferation (RAP) and to examine the utility of an advanced retinal pigment epithelium (RPE) analysis performed using spectral-domain optical coherence tomography (SD-OCT).

Methods We retrospectively reviewed 17 treatment-naïve eyes in 14 patients (4 men, 10 women; age range 71–87 years; mean age 80 years) treated with IVR. All the patients received three consecutive monthly injections of 0.5 mg/0.05 mL of ranibizumab as an induction treatment. Retreatment was allowed if evidence of clinical deterioration was noted or if an SD-OCT examination performed at a 1-month follow-up showed intraretinal oedema, subretinal fluid, or recurrent pigment epithelial detachment. The primary outcome measures were best-corrected visual acuity (BCVA) and central foveal thickness (CFT) as evaluated using SD-OCT. Furthermore, we investigated the atrophic area at 36 months using advanced RPE analysis provided by SD-OCT and analysed the correlation with the BCVA.

Results The mean BCVA was well maintained from 0.57 at baseline to 0.52 at 36 months (p=0.219). The CFT decreased significantly from 317 to 223 µm at 36 months (p<0.001). The mean number of injections was 10.2. Sixteen of the 17 patients (94.1%) showed recurrence during the maintenance phase. Better visual acuity at 36 months was also associated with better visual acuity at baseline and absence of macular atrophy (MA) identified with advanced RPE analysis at 36 months (p<0.001, p=0.012, respectively).

Conclusions The intravitreal injection of ranibizumab was effective for stabilising vision in patients with RAP, as evaluated at a 3-year follow-up examination. Advanced RPE analysis is useful for investigating atrophic areas after IVR. Visual acuity at baseline and progression of MA might be important for BCVA after IVR.