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The efficacy of the anti-VEGF as monotherapy in the treatment of RAP (retinal angiomatous proliferation) stage 1 and stage 2 with the visual and functional outcomes caring the best prognosis

Session Details

Session Title: AMD I

Session Date/Time: Thursday 17/09/2015 | 08:30-10:30

Paper Time: 08:38

Venue: Athena

First Author: : C.Koutsiouki UNITED KINGDOM

Co Author(s): :    S. Sivaprasad              

Abstract Details

PURPOSE:To establish that the early detection of retinal angiomatous profilers (RAP)  lesion  stage 1 and stage 2 enables earlier treatment  with anti-VEGF agents leading to  significant  lesion  regression and prevention  of substantial photoreceptors loss with consequent favourable visual outcome.

Setting:

Retrospective analysis of  case notes and imaging in Moorfields Eye Hospital.

Methods:

PARTICIPANTS :All patients were diagnosed with stage 1 and stage 2 RAP lesions using a combination of well-established characteristics of these lesions on SD-OCT, fluorescein and  indocyanine angiography. INTERVENTION : After the initial diagnosis the patient were treated with either ranibizumab on a PRN protocol or  aflibercept on a treat and extend protocol. MAIN OUTCOME MEASURES : The visual and anatomical outcomes defined as best corrected visual acuity ( BCVA) and morphological features on SD-OCT .

Results:

A total of 16 patients (17 eyes) were included , 8 with RAP lesion stage 1 and 9 stage 2. In RAP stage 1, the  BCVA remained  stable completely  resolved in 87.5% (7/8)  of the RAP 1 lesion and the rest showed partial resolution. In RAP lesions stage 2, the BCVA remained  stable in 55,5% (5/9) with less than 12 letters gain in the EDTRS chart and 44.5% improved with more than 12 letters gain .The intraretinal and subretinal fluid (IRF,SRF) also completely resolved in all cases. The pigment epithelium detachment ( PED) was observed in 33.3 % (3/9) and the PED resolved in one case, partially reduced in one and remained unchanged in the third case.

Conclusions:

Patients with RAP stage 1 lesion have the best visual and functional outcomes.  In RAP stage 1 , the majority of patients showed significant visual improvement and complete resolution of IRF.  Although RAP stage 2 did not do as well as stage 1, all the patients responded to both the anti-VEGF agents with complete resolution of the IRF and or  SRF in 94. 6 % and in only one case the PED remained stable  establishing the efficacy of the anti-VEGF as monotherapy . As a conclusion the early stage detection of RAP lesion and the prompt treatment at early stage prevents the progression of these lesions to stage 3 and 4, which carries worse  prognosis .

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