Treatment of Bilateral Retinal Angiomatous Proliferation with Anti-vascular Endothelial Growth Factor: 12-Month Outcome

Abstract

Purpose: To evaluate the 12-month outcome of intravitreal anti-vascular endothelial growth factor therapy in eyes with bilateral retinal angiomatous proliferation (RAP).

Methods: This retrospective observational study included 38 eyes of 19 patients with stage 1 or 2 bilateral RAP at diagnosis. The eyes of patients who exhibited different baseline best-corrected visual acuity (BCVA) values in both eyes were assigned to one of two groups-the better (n=13) and worse (n=13) visual acuity groups. The BCVA values in both groups were compared to those at baseline and at 12 months. In addition, the 12-month changes in BCVA were compared between the two groups. The association between the optical coherence tomography findings at diagnosis and the 12-month BCVA was also analyzed.

Results: The values of mean baseline and 12-month BCVA in the better visual acuity group (13 eyes) were 0.48 ± 0.19 and 0.58 ± 0.29, respectively, and those in the worse visual acuity group (13 eyes) were 0.83 ± 0.20 and 0.90 ± 0.31. The 12-month changes in BCVA were not significantly different between the two groups (p=0.786). Among the six patients with equivalent baseline BCVA in both eyes, four patients (66.7%) exhibited 1 to 2 lines or ≥3 lines of difference in BCVA between eyes at 12 months. Eyes without pigment epithelial detachment (PED) at diagnosis exhibited significantly better BCVA at 12 months than eyes with PED (p=0.021).

Conclusions: Better baseline visual acuity was associated with better BCVA at 12 months posttreatment in patients with bilateral RAP. However, equivalent baseline visual acuity in both eyes might not guarantee similar treatment outcomes. In addition, the absence of PED is predictive of better visual outcome.

Keywords: Bevacizumab; Choroidal neovascularization; Macular degeneration; Ranibizumab; Retinal angiomatous proliferation.

Fig. 1. A representative case showing treatment outcome of bilateral retinal angiomatous proliferation. At diagnosis (A-F), the visual acuities of the right and left eyes were 20 / 50 and 20 / 50, respectively (arrows in panels C and D indicate the retinal angiomatous proliferation lesion). The eyes were treated with anti-vascular endothelial growth factor for 12 months. At 12 months posttreatment (G-J), despite a mild recurrence of exudation in the left eye, the visual acuities of the right (G,I) and left (H,J) eyes had improved to 20 / 25 and 20 / 30, respectively. (A,B,G,H): Fundus photography images; (C,D): indocyanine green angiography images; (E,F,I,J): optical coherence tomography images.

Fig. 2. Scatterplot showing the association of baseline and 12-month logarithm of minimal angle of resolution (logMAR) best-corrected visual acuity (BCVA) values between the eyes of a pair. Positive values indicate better visual acuity of the right eye compared to that of the left eye, and negative values indicate better visual acuity of the left eye compared to that of the right eye.

Fig. 3. Results of best-corrected visual acuity (BCVA) evaluation in eyes with bilateral retinal angiomatous proliferation divided into subgroups according to the baseline VA. (A) Changes in BCVA in 13 patients exhibiting different BCVA values in both eyes at baseline. Closed circles (solid line) indicate eyes with better baseline VA, and closed squares (dashed line) indicate eyes with worse baseline VA. (B) Changes in the proportions of patients exhibiting the equivalent VA, 1 to 2 lines of difference in BCVA, and ≥3 lines of difference in BCVA in both eyes from baseline to 12 months posttreatment. These data were derived from six patients with equivalent baseline BCVA in both eyes. logMAR = logarithm of minimal angle of resolution.

Fig. 4. Results of best-corrected visual acuity (BCVA) evaluation in eyes with bilateral retinal angiomatous proliferation (RAP) divided into subgroups according to stage of disease. (A) Changes in BCVA in eight patients exhibiting different stages of RAP in paired eyes. Closed circles (solid line) indicate eyes with lower stage (stage 1) of disease, and closed squares (dashed line) indicate eyes with higher stage (stage 2) of disease. (B) Changes in the proportions of patients exhibiting equivalent visual acuity, 1 to 2 lines of difference in BCVA, and ≥3 lines of difference in BCVA in paired eyes from baseline to 12 months posttreatment. These data were derived from 11 patients with the same stage of RAP in paired eyes. logMAR = logarithm of minimal angle of resolution.