Egbert Matthé, Dirk Sandner and Johanna Maaß
Background: Retinal Angiomatous Proliferations (RAP) is a subgroup of exsudative or “wet” Age-related Macular Degeneration (wAMD) with devastating reduction of visual acuity in later stages. Intravitreal Ranibizumab provides a good therapy, but is considered to be not as effective in this class of neovascularization compared to choroidal neovascularization (CNV). We investigated the efficacy of Ranibizumab in late stage III RAP with retino-choroidal anastomosis compared to the outcome of CNV lesions. Methods: Retrospective analysis of the data of all for wAMD with Ranibizumab treated patients. Patients were divided into groups depending on the lesion type into RAP (identified and selected clinically, proven by fluorescein angiography) and CNV types (identified by fluorescein angiography only) named occult, minimally and predominantly classic groups. Best-corrected visual acuity (BCVA) was obtained before (“diagnosis”), during (1st, 2nd and 3rd injection) and after upload (“1st control”). Results: Before first injection the visual acuity decreased in all groups (0.73 to 0.78 logMAR for all CNV, 0.95 to 1.02 logMAR for RAP). During upload there is no further decline in visual acuity but no improvement as well up to the 1st control visit in the RAP group (1.02 to 1.03 logMAR), but a statistically significant increase in all other groups (0.78 to 0.67 logMAR). Conclusion: Clinically identified late stage III RAP lesions with retino-choroidal anastomosis respond worse to treatment with monthly Ranibizumab than all other lesion types regardless of their severity. Treatment results in stabiliziation of visual acuity, but – in contrast to other forms of CNV – no further improvement. Therefore, patients with this special form need to be identified and treated as early as possible.
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