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Kim, Kim, Jeong, Lee, Kim, Kim, Cho, Lee, and Han: Twelve-Month Outcomes of Intravitreal Anti-Vascular Endothelial Growth Factor Therapy for Retinal Angiomatous Proliferation
Original Article

J Korean Ophthalmol Soc 2013;54(11):1700-1707.

Published online: 2 September 2013

DOI: https://doi.org/10.3341/jkos.2013.54.11.1700

Twelve-Month Outcomes of Intravitreal Anti-Vascular Endothelial Growth Factor Therapy for Retinal Angiomatous Proliferation

Deok Bae Kim, MD1, Jae Hui Kim, MD2, Seong Hun Jeong, MD2, Tae Gon Lee, MD2, Jong Woo Kim, MD2, Chul Gu Kim, MD2, Sung Won Cho, MD2, Dong Won Lee, MD2, Jung I1 Han, MD2

1Happyeye21 Hospital, Gwangju, Korea

2Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Korea

Address reprint requests to Jae Hui Kim, MD, Kim's Eye Hospital, #136 Yeongsin-ro, Yeongdeungpo-gu, Seoul 150-034, Korea, Tel: 82-2-2671-7665, Fax: 82-2-2671-6359, E-mail: kjh7997@daum.net

Received 21 June 2013       Revised 7 September 2013       Accepted 28 October 2013

Copyright © 2013 Korean Ophthalmological Society

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the 12-month outcomes of anti-vascular endothelial growth factor (VEGF) treatment for patients with retinal angiomatous proliferation (RAP).

Methods

Retrospective review of medical records was performed for 33 patients (33 eyes) who were diagnosed with RAP. All patients were initially treated with three consecutive intravitreal anti-VEGF injections after diagnosis. Additional treatment was performed when the recurrence of exudation was noted. The best-corrected visual acuity (BCVA) was measured before the first injection and at 3, 6, and 12 months after the first injection. The value measured before the treatment was compared with those measured after treatment.

Results

The patients received an average of 4.2 ± 1.7 intravitreal anti-VEGF injections during the 12-month follow-up period. The logarithm of minimal angle of resolution (log MAR) values of BCVA before the first injection and at 3, 6, and 12 months after the first injections were 0.76 ± 0.49, 0.55 ± 0.35, 0.67 ± 0.41, and 0.70 ± 0.50, respectively. BCVA was significantly improved at 3 and 6 months (p < 0.001 and p = 0.037) compared to that measured before the first injection. However, there was no significant difference between BCVA before the first injection and 12 months after the first injection (p = 0.590). At 12 months of follow-up, 29 eyes (87.9%) showed stable (<2 log MAR lines of change) or improved (52 log MAR lines of improvement) BCVA.

Conclusions

Anti-VEGF therapy was found to be beneficial in both normalizing macular thickness and in improving or maintaining visual acuity in the majority of patients with RAP.

Keywords: Anti-vascular endothelial growth factor, Clinical outcomes, Retinal angiomatous proliferation, Visual acuity

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Figure 1.
Central foveal thickness (double-head arrow) was defined as the vertical distance between internal limiting membrane and retinal pigment epithelium at foveal center based on optical coherence tomography image centered at the center of the fovea.
jkos-54-1700f1.tif
Figure 2.
Fundus photography (A), indocyanine green angiography (B), and optical coherence tomography (C) images in an eye with retinal angiomatous proliferation. Arrow (B) on indocyanine green angiography image indicates retinal angiomatous proliferation lesion. Optical coherence tomography images showing macular microstructure before treatment (C1) and 3 months (C2), 8 months (C3), and 12 months (C4) after the first intravitreal anti-vascular endothelial growth factor injection. Recurrence of exudation was noted at 8 months following the first treatment. The best-corrected visual acuity measured before treatment was 20/40. The visual acuity was improved to 20/30 after three monthly injections, but deteriorated to 20/60 after the recurrence of exudation. At 12-month after the first treatment, the visual acuity was measured as 20/40.
jkos-54-1700f2.tif
Figure 3.
Twelve-month changes in logarithm of minimal angle of resolution (log MAR) best-corrected visual acuity (A, BCVA) and central foveal thickness (B) in eyes with retinal angiomatous proliferation that were treated with anti-vascular growth factor mono-treatment, according to the follow-up period. Statistical analysis was performed using repeated measures analysis of variances.
jkos-54-1700f3.tif
Figure 4.
(A-D) Baseline fundus photography (A), fluorescein angiography (B), indocyanine green angiography (C), and optical coherence tomography (D) findings of an eye with retinal angiomatous proliferation. (E-G) Twelve months after anti-vascular endothelial growth factor treatment, resolution of retinal hemorrhage (E) cessation of leakage (F) and resolution of intraretinal and subretinal fluid (G) was noted. The visual acuity was improved from 20/400 to 20/100.
jkos-54-1700f4.tif
Table 1.
Characteristics of 33 included eyes (33 patients) with retinal angiomatous proliferation
Characteristics
Age (years) 75.2 ± 6.1
Sex (n, %)
 Male 5 (15.2)
 Female 28 (84.8)
Classification (n, %)
 Type 1 12 (36.4)
 Type 2 14 (42.4)
 Type 3 7 (21.2)
Best-corrected visual acuity (log MAR) 0.76 ± 0.49
Central foveal thickness (μm) 356.8 ± 70.9
No. of anti-VEGF injections 4.2 ± 1.7
No. of hospital visit 7.3 ± 0.9

Values are presented as mean ± SD.

SD = standard deviation; VEGF = vascular endothelial growth factor; log MAR = logarithm of minimal angle of resolution.

Table 2.
Distribution of eyes according to the degree of visual acuity change between at diagnosis and at 12-month following the first anti-vascular endothelial growth factor injection (N = 33)
Degree of change No. of eyes (%)
≥0.2 log MAR of gain 13 (39.4)
Stable 16 (48.5)
≥0.2 log MAR of loss 4 (12.1)
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