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Intravitreal ranibizumab (Lucentis®) in the treatment of retinal angiomatous proliferation (RAP)

  • Retinal Disorders
  • Published:
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Abstract

Background

Retinal angiomatous proliferation (RAP) is a distinct variant of neovascular age-related macular degeneration (AMD). The aim of this study is to evaluate the functional and anatomic outcome after intravitreal ranibizumab (Lucentis) treatment in patients with RAP.

Methods

Prospective study of consecutive patients with newly diagnosed or recurrent RAP treated with intravitreal ranibizumab at the Jules Gonin Eye Hospital between March 2006 and December 2007. Baseline and monthly follow-up visits included best-corrected visual acuity (BCVA), fundus exam and optical coherence tomography. Fluorescein and indocyanine green angiography were performed at baseline and repeated at least every 3 months.

Results

Thirty-one eyes of 31 patients were treated with 0.5 mg of intravitreal ranibizumab for RAP between March 2006 and December 2007. The mean age of the patients was 82.6 years (SD:4.9). The mean number of intravitreal injections administered for each patient was 5 (SD: 2.4, range 3 to 12). The mean follow up was 13.4 months (SD: 3, range 10 to 22). The baseline mean logMAR BCVA was 0.72 (SD: 0.45) (decimal equivalent of 0.2). The mean logMAR BCVA was improved significantly (P < 0.0001) at the last follow-up to 0.45, SD: 0.3 (decimal equivalent 0.35). The visual acuity (VA) improved by a mean of 2.7 lines (SD 2.5). Mean baseline central macular thickness (CMT) was 376 μm, and decreased significantly to a mean of 224 μm (P < 0.001) at the last follow-up. Mean reduction of CMT was 152 μm (SD: 58). An average of 81.5% of the total visual improvement and 85% of the total CMT reduction occurred during the first post-operative month after one intravitreal injection of ranibizumab. During follow-up, an RPE tear occurred in one eye (3.2%) of the study group. No injection complications or systemic drug-related side-effects were noted during the follow-up period.

Conclusions

Intravitreal ranibizumab injections appeared to be an effective and safe treatment for RAP, resulting in visual gain and reduction in macular thickness. Further long-term studies to evaluate the efficacy of intravitreal ranibizumab in RAP are warranted.

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References

  1. Freund KB, Ho IV, Barbazetto IA, Koizumi H, Laud K, Ferrara D, Matsumoto Y, Sorenson JA, Yannuzzi L (2008) Type 3 neovascularization: The expanded spectrum of retinal angiomatous proliferation. Retina 28:201–211, doi:10.1097/IAE.0b013e3181669504

    Article  PubMed  Google Scholar 

  2. Yannuzzi LA, Freund KB, Takahashi BS (2008) Review of retinal angiomatous proliferation or type 3 neovascularization. Retina 28:375–384, doi:10.1097/IAE.0b013e3181619c55

    Article  PubMed  Google Scholar 

  3. Yannuzzi LA, Negrao S, Iida T, Carvalho C, Rodriguez-Coleman H, Slakter J, Freund KB, Sorenson J, Orlock D, Borodoker N (2001) Retinal angiomatous proliferation in age-related macular degeneration. Retina 21:416–434, doi:10.1097/00006982-200110000-00003

    Article  PubMed  CAS  Google Scholar 

  4. Gross NE, Aizman A, Brucker A, Klancnik JM Jr, Yannuzzi LA (2005) Nature and risk of neovascularization in the fellow eye of patients with unilateral retinal angiomatous proliferation. Retina 25:713–718, doi:10.1097/00006982-200509000-00005

    Article  PubMed  Google Scholar 

  5. Bottoni F, Massacesi A, Cigada M, Viola F, Musicco I, Staurenghi G (2005) Treatment of retinal angiomatous proliferation in age-related macular degeneration: A series of 104 cases of retinal angiomatous proliferation. Arch Ophthalmol 123:1644–1650, doi:10.1001/archopht.123.12.1644

    Article  PubMed  Google Scholar 

  6. van de Moere A, Kak R, Sandhu SS, Talks SJ (2007) Anatomical and visual outcome of retinal angiomatous proliferation treated with photodynamic therapy and intravitreal triamcinolone. Am J Ophthalmol 143:701–704, doi:10.1016/j.ajo.2006.10.045

    Article  PubMed  CAS  Google Scholar 

  7. Shiragami C, Iida T, Nagayama D, Baba T, Shiraga F (2007) Recurrence after surgical ablation for retinal angiomatous proliferation. Retina 27:198–203, doi:10.1097/01.iae.0000224938.61915.f0

    Article  PubMed  Google Scholar 

  8. Rutishauser-Arnold Y, Tholen AM (2007) Periocular sub-tenon triamcinolone acetonide injections for the treatment of retinal angiomatous proliferation (rap) and occult choroidal neovascularisation. Klin Monatsbl Augenheilkd 224:269–273, doi:10.1055/s-2006-927396

    Article  PubMed  CAS  Google Scholar 

  9. Roth DB, Scott IU, Gloth JM, Green SN, Yarian DL, Wheatley M (2007) Micropulsed laser photocoagulation and intravitreal triamcinolone acetonide injection for the treatment of retinal angiomatous proliferation. Retina 27:1201–1204, doi:10.1097/IAE.0b013e3180ed45a6

    Article  PubMed  Google Scholar 

  10. Reche-Frutos J, Calvo-Gonzalez C, Donate-Lopez J, Garcia-Feijoo J, Saenz-Frances F, Fernandez-Perez C, Garcia-Sanchez J (2007) Retinal angiomatous proliferation reactivation 6 months after high-dose intravitreal acetonide triamcinolone and photodynamic therapy. Eur J Ophthalmol 17:979–982

    PubMed  CAS  Google Scholar 

  11. Nicolo M, Ghiglione D, Lai S, Calabria G (2006) Retinal angiomatous proliferation treated by intravitreal triamcinolone and photodynamic therapy with verteporfin. Graefes Arch Clin Exp Ophthalmol 244:1336–1338, doi:10.1007/s00417-006-0306-6

    Article  PubMed  CAS  Google Scholar 

  12. Nakata M, Yuzawa M, Kawamura A, Shimada H (2006) Combining surgical ablation of retinal inflow and outflow vessels with photodynamic therapy for retinal angiomatous proliferation. Am J Ophthalmol 141:968–970, doi:10.1016/j.ajo.2005.12.029

    Article  PubMed  Google Scholar 

  13. Mantel I, Ambresin A, Zografos L (2006) Retinal angiomatous proliferation treated with a combination of intravitreal triamcinolone acetonide and photodynamic therapy with verteporfin. Eur J Ophthalmol 16:705–710

    PubMed  CAS  Google Scholar 

  14. Krieglstein TR, Kampik A, Ulbig M (2006) Intravitreal triamcinolone and laser photocoagulation for retinal angiomatous proliferation. Br J Ophthalmol 90:1357–1360, doi:10.1136/bjo.2006.092536

    Article  PubMed  CAS  Google Scholar 

  15. Klais CM, Eandi CM, Ober MD, Sorenson JA, Sadeghi SN, Freund KB, Spaide RF, Slakter JS, Yannuzzi LA (2006) Anecortave acetate treatment for retinal angiomatous proliferation: A pilot study. Retina 26:773–779, doi:10.1097/01.iae.0000244261.52901.67

    Article  PubMed  Google Scholar 

  16. Freund KB, Klais CM, Eandi CM, Ober MD, Goldberg DE, Sorenson JA, Yannuzzi LA (2006) Sequenced combined intravitreal triamcinolone and indocyanine green angiography-guided photodynamic therapy for retinal angiomatous proliferation. Arch Ophthalmol 124:487–492, doi:10.1001/archopht.124.4.487

    Article  PubMed  CAS  Google Scholar 

  17. Bottoni F, Romano M, Massacesi A, Bergamini F (2006) Remodeling of the vascular channels in retinal angiomatous proliferations treated with intravitreal triamcinolone acetonide and photodynamic therapy. Graefes Arch Clin Exp Ophthalmol 244:1528–1533, doi:10.1007/s00417-006-0311-9

    Article  PubMed  CAS  Google Scholar 

  18. Boscia F, Parodi MB, Furino C, Reibaldi M, Sborgia C (2006) Photodynamic therapy with verteporfin for retinal angiomatous proliferation. Graefes Arch Clin Exp Ophthalmol 244:1224–1232. doi:10.1007/s00417-005-0205-2

    Article  PubMed  CAS  Google Scholar 

  19. Shimada H, Mori R, Arai K, Kawamura A, Yuzawa M (2005) Surgical excision of neovascularization in retinal angiomatous proliferation. Graefes Arch Clin Exp Ophthalmol 243:519–524, doi:10.1007/s00417-004-1073-x

    Article  PubMed  Google Scholar 

  20. Boscia F, Furino C, Prascina F, Delle Noci N, Sborgia L, Sborgia C (2005) Combined surgical ablation and intravitreal triamcinolone acetonide for retinal angiomatous proliferation. Eur J Ophthalmol 15:513–516

    PubMed  CAS  Google Scholar 

  21. Borrillo JL, Sivalingam A, Martidis A, Federman JL (2003) Surgical ablation of retinal angiomatous proliferation. Arch Ophthalmol 121:558–561, doi:10.1001/archopht.121.4.558

    Article  PubMed  Google Scholar 

  22. Kuroiwa S, Arai J, Gaun S, Iida T, Yoshimura N (2003) Rapidly progressive scar formation after transpupillary thermotherapy in retinal angiomatous proliferation. Retina 23:417–420, doi:10.1097/00006982-200306000-00027

    Article  PubMed  Google Scholar 

  23. Shimada H, Kawamura A, Mori R, Yuzawa M (2007) Clinicopathological findings of retinal angiomatous proliferation. Graefes Arch Clin Exp Ophthalmol 245:295–300, doi:10.1007/s00417-006-0367-6

    Article  PubMed  Google Scholar 

  24. Rakic JM, Lambert V, Devy L, Luttun A, Carmeliet P, Claes C, Nguyen L, Foidart JM, Noel A, Munaut C (2003) Placental growth factor, a member of the vegf family, contributes to the development of choroidal neovascularization. Invest Ophthalmol Vis Sci 44:3186–3193, doi:10.1167/iovs.02-1092

    Article  PubMed  Google Scholar 

  25. Otani A, Takagi H, Oh H, Koyama S, Ogura Y, Matumura M, Honda Y (2002) Vascular endothelial growth factor family and receptor expression in human choroidal neovascular membranes. Microvasc Res 64:162–169, doi:10.1006/mvre.2002.2407

    Article  PubMed  CAS  Google Scholar 

  26. Costagliola C, Romano MR, dell’Omo R, Cipollone U, Polisena P (2007) Intravitreal bevacizumab for the treatment of retinal angiomatous proliferation. Am J Ophthalmol 144:449–451, doi:10.1016/j.ajo.2007.05.025

    Article  PubMed  CAS  Google Scholar 

  27. Meyerle CB, Freund KB, Iturralde D, Spaide RF, Sorenson JA, Slakter JS, Klancnik JM Jr, Fisher YL, Cooney MJ, Yannuzzi LA (2007) Intravitreal bevacizumab (avastin) for retinal angiomatous proliferation. Retina 27:451–457, doi:10.1097/IAE.0b013e318030ea80

    Article  PubMed  Google Scholar 

  28. Ghazi NG, Knape RM, Kirk TQ, Tiedeman JS, Conway BP (2008) Intravitreal bevacizumab (avastin) treatment of retinal angiomatous proliferation. Retina 28:689–695, doi:10.1097/IAE.0b013e318162d982

    Article  PubMed  Google Scholar 

  29. Bashshur ZF, Haddad ZA, Schakal A, Jaafar RF, Saab M, Noureddin BN (2008) Intravitreal bevacizumab for treatment of neovascular age-related macular degeneration: A one-year prospective study. Am J Ophthalmol 145:249–256, doi:10.1016/j.ajo.2007.09.031

    Article  PubMed  CAS  Google Scholar 

  30. Joeres S, Heussen FM, Treziak T, Bopp S, Joussen AM (2007) Bevacizumab (avastin) treatment in patients with retinal angiomatous proliferation. Graefes Arch Clin Exp Ophthalmol 245:1597–1602, doi:10.1007/s00417-007-0580-y

    Article  PubMed  CAS  Google Scholar 

  31. Lai TY, Chan WM, Liu DT, Lam DS (2007) Ranibizumab for retinal angiomatous proliferation in neovascular age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol 245:1877–1880, doi:10.1007/s00417-007-0679-1

    Article  PubMed  CAS  Google Scholar 

  32. Rosenfeld PJ, Brown DM, Heier JS, Boyer DS, Kaiser PK, Chung CY, Kim RY (2006) Ranibizumab for neovascular age-related macular degeneration. N Engl J Med 355:1419–1431, doi:10.1056/NEJMoa054481

    Article  PubMed  CAS  Google Scholar 

  33. Holladay JT (1997) Proper method for calculating average visual acuity. J Refract Surg 13:388–391

    PubMed  CAS  Google Scholar 

  34. Regillo CD, Brown DM, Abraham P, Yue H, Ianchulev T, Schneider S, Shams N (2008) Randomized, double-masked, sham-controlled trial of ranibizumab for neovascular age-related macular degeneration: Pier study year 1. Am J Ophthalmol 145:239–248 e235

    Article  PubMed  CAS  Google Scholar 

  35. Fung AE, Lalwani GA, Rosenfeld PJ, Dubovy SR, Michels S, Feuer WJ, Puliafito CA, Davis JL, Flynn HW Jr, Esquiabro M (2007) An optical coherence tomography-guided, variable dosing regimen with intravitreal ranibizumab (lucentis) for neovascular age-related macular degeneration. Am J Ophthalmol 143:566–583, doi:10.1016/j.ajo.2007.01.028

    Article  PubMed  CAS  Google Scholar 

  36. Rouvas AA, Papakostas TD, Vavvas D, Vergados I, Moschos MM, Kotsolis A, Ladas ID (2009) Intravitreal ranibizumab, intravitreal ranibizumab with PDT, and intravitreal triamcinolone with PDT for the treatment of retinal angiomatous proliferation: a prospective study. Retina 29:536–544

    Article  PubMed  Google Scholar 

  37. Forooghian F, Cukras C, Chew EY (2008) Retinal angiomatous proliferation complicated by pigment epithelial tear following intravitreal bevacizumab treatment. Can J Ophthalmol 43:246–248, doi:10.3129/I08-017

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Hôpital Ophtalmique Jules Gonin, University of Lausanne, 15 Av. de France, 1004, Lausanne, Switzerland

    Lazaros Konstantinidis, Evangelia Mameletzi, Irmela Mantel, Jean-Antoine Pournaras, Leonidas Zografos & Aude Ambresin

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  1. Lazaros Konstantinidis
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  2. Evangelia Mameletzi
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  3. Irmela Mantel
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  4. Jean-Antoine Pournaras
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  5. Leonidas Zografos
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  6. Aude Ambresin
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Correspondence to Aude Ambresin.

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Konstantinidis, L., Mameletzi, E., Mantel, I. et al. Intravitreal ranibizumab (Lucentis®) in the treatment of retinal angiomatous proliferation (RAP). Graefes Arch Clin Exp Ophthalmol 247, 1165–1171 (2009). https://doi.org/10.1007/s00417-009-1089-3

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  • DOI: https://doi.org/10.1007/s00417-009-1089-3

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