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Intravitreales Ranibizumab für die Behandlung von retinalen angiomatösen Proliferationen

Intravitreal ranibizumab for the treatment of retinal angiomatous proliferation

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Zusammenfassung

Hintergrund

Retinale angiomatöse Proliferationen (RAP) stellen eine Sonderform der bei exsudativer bzw. „neovaskulärer“ altersbedingter Makuladegeneration (nAMD) auftretenden Neovaskularisationen dar. Häufig sind sie mit einem massiven Visusverlust assoziiert. Intravitreales Ranibizumab ist eine häufig angewendete Therapiemethode. Allerdings ist die Effektivität geringer im Vergleich zu anderen choroidalen Neovaskularisationen.

Ziel der Arbeit (Fragestellung)

Wir untersuchten die Effektivität von Ranibizumab im späten Stadium RAP III mit retinochoroidalen Anastomosen im Vergleich zum Outcome von anderen CNV-Läsionen.

Material und Methoden

Es handelt sich um eine retrospektive Analyse von allen Ranibizumab-behandelten Patienten mit nAMD. Die Patienten wurden unterteilt in Gruppen abhängig vom Läsionstypus in RAP (klinisch identifiziert und selektiert, bewiesen durch Fluoreszenzangiographie) und in CNV-Läsion (identifiziert durch Fluoreszenzangiographie) mit Einteilung in okkult, minimal und überwiegend klassisch. Der bestkorrigierte Visus (BCVA) wurde vor (zum Zeitpunkt „Diagnose“) und während (erste, zweite, dritte Injektion) der Behandlung erhoben sowie nach der Upload-Phase (1. Kontrollvisite).

Ergebnisse

Vor der ersten Injektion verschlechterte sich der Visus in allen Gruppen (0,73 zu 0,78 logMAR für alle CNV-Läsionen; 0,95 zu 1,02 logMAR für RAP). Während der Upload-Phase kam es in der RAP-Gruppe zu keiner weiteren Visusverschlechterung, aber auch zu keiner Verbesserung (1,02 zu 1,03 logMAR), in der anderen Gruppe kam es jedoch zu einem signifikanten Visusanstieg (0,78 zu 0,67 logMAR).

Diskussion

Die Behandlung des späten Stadiums III bei RAP-Läsionen mit Ranibizumab ist effektiv. Stabilisierung des Visus kann erreicht werden – aber im Unterschied zu anderen CNV-Läsionen keine weitere Verbesserung. Daher sollten Patienten mit RAP-Läsionen so früh wie möglich identifiziert und behandelt werden.

Abstract

Background

Retinal angiomatous proliferations (RAP) are a subgroup of exsudative or “wet” age-related macular degeneration (wAMD) with devastating reduction of visual acuity in later stages. Intravitreal ranibizumab provides good therapy, but is considered to be less effective than in other choroidal neovascularizations (CNV).

Objective

We investigated the efficacy of ranibizumab in late-stage III RAP with retinochoroidal anastomosis compared to the outcome of other CNV lesions.

Materials and methods

The data of all patients with wAMD treated with ranibizumab were retrospectively analyzed. Patients were divided into groups depending on the lesion type into RAP (identified and selected clinically, proven by fluorescein angiography) and CNV lesions (identified by fluorescein angiography only) named occult, minimally and predominantly classic groups. The best-corrected visual acuity (BCVA) was obtained before (at the timepoint “diagnosis”), during (1st, 2nd, and 3rd injection), and after upload (“1st control”).

Results

Before first injection, visual acuity decreased in all groups (0.73 to 0.78 logMAR for all CNV, 0.95 to 1.02 logMAR for RAP). During upload there was no further decline in visual acuity but no improvement as well up to the 1st control visit in the RAP group (1.02 to 1.03 logMAR), but a statistically significant increase in all other groups (0.78 to 0.67 logMAR).

Conclusion

Treatment of late-stage III RAP with ranibizumab is effective. Stabiliziation of visual acuity can be achieved, but—in contrast to other forms of CNV lesions—no further improvement. Therefore, patients with this special form need to be identified and treated as early as possible.

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Authors and Affiliations

  1. Klinik und Poliklinik für Augenheilkunde, Medizinische Fakultät „Carl Gustav Carus“, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland

    J. Maaß, D. Sandner & E. Matthé

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Maaß, J., Sandner, D. & Matthé, E. Intravitreales Ranibizumab für die Behandlung von retinalen angiomatösen Proliferationen. Ophthalmologe 114, 534–542 (2017). https://doi.org/10.1007/s00347-016-0378-6

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