Long-term outcomes and the association between early detection of retinal pigment epithelial atrophy and remission after loading dose in eyes with retinal angiomatous proliferation.

PURPOSE

To investigate the association between early detection of retinal pigment epithelial (RPE) atrophy after anti-vascular endothelial growth factor (VEGF) treatment and the long-term treatment outcomes in eyes with retinal angiomatous proliferation (RAP).

STUDY DESIGN

A retrospective observational study METHODS: All patients with treatment-naive RAP initially received three monthly anti-VEGF administration with or without photodynamic therapy (PDT), followed by as-needed anti-VEGF administration. At 12 months post-injection, they were divided into two groups depending on the presence or absence of RPE atrophy. The visual and anatomic outcomes, and the incidence of 12-month remission were investigated within a 48-month follow-up.

RESULTS

Thirty-seven eyes of 37 patients were included. The mean age was 80.4 ± 7.0 years, 54% were women. In the atrophy (+) group, 58.3% of patients achieved 12-month remission, significantly higher than the atrophy (-) group (p = 0.04). During the study period, best corrected visual acuity in the atrophy (+) group deteriorated from 0.50 ± 0.43 logMAR to 0.66 ± 0.47 logMAR (p = 0.14), while in the atrophy (-) group, it deteriorated significantly from 0.48 ± 0.27 logMAR to 0.76 ± 0.42 logMAR (p = 6.7×10). The mean additional injections in the atrophy (+) group were significantly smaller compared with the atrophy (-) group at 3.5 ± 4.7 versus 15.3 ± 4.3, respectively (p = 9.0×10).

CONCLUSION

Early detection of RPE atrophy was associated with the incidence of 12-month remission and reduced number of additional injections. The formation of RPE atrophy might suggest a decrease in the disease activity of RAP.