Long-term visual and anatomical outcomes following anti-VEGF monotherapy for retinal angiomatous proliferation

Aim To study the long-term visual and anatomical outcomes of antivascular endothelial growth factor (VEGF) monotherapy for the treatment of patients with retinal angiomatous proliferation (RAP). Methods Retrospective review of patients who were diagnosed as having AMD and RAP lesions, and who received anti-VEGF injections as the only mode of therapy. Results 20 eyes (15 patients; nine women, six men) with RAP lesions treated by anti-VEGF were encountered. The mean patient age was 85.8 years (SD±4.54). Nine eyes were treated with intravitreal ranibizumab alone, eight eyes were treated with bevacizumab alone, and three eyes received both drugs. At 1, 3 and 6 months' follow-up the median VA had improved from baseline (20/72) to 20/52 (range: 20/25 to 20/400), 20/45 (range 20/20 to 20/400), and 20/56 (range 20/20 to 20/400), respectively, (p>0.001, p=0.001 and p=0.05, respectively). At the 24-month follow-up, the improvement in VA, defined as a halving of the visual angle, occurred in 37.5% of the cases. Conclusions Anti-VEGF monotherapy represents a useful treatment option for RAP, with stable or improved visual acuity in 62.5% of patients at 2 years. 25% of eyes required only a single injection, but in most cases (75%) repeated treatments were required, highlighting the need for long term follow-up. Although, in this small study, the results for visual improvement were not statistically significant beyond 3 months, our findings warrant further large-scale investigation.