Ranibizumab in retinal angiomatous proliferation (RAP): influence of RAP stage on visual outcome

Eur J Ophthalmol. 2011 Nov-Dec;21(6):783-8. doi: 10.5301/EJO.2011.6526.


Purpose: To evaluate the influence of retinal angiomatous proliferation (RAP) stage on visual and anatomic outcome after ranibizumab (Lucentis®).

Methods: This was a prospective study on consecutively diagnosed RAP eyes at the Hospital Clínico San Carlos, Madrid. Best-corrected visual acuity (BCVA) and optical coherence tomography (OCT) are performed monthly. Indocyanine green angiography (ICG) and fluorescein angiography (FA) are performed at baseline and every 3 months thereafter. A starting dose of a monthly ranibizumab injection in the first 3 months is followed by retreatment in case of intraretinal edema, subretinal fluid, or pigment epithelium detachment (PED) in OCT, increased leakage in FA, or a hot spot in ICG.

Results: A total of 53 eyes from 49 patients were included. The mean change in BCVA at 12 months was +7.3, +0.83, and -2.1 letters in stages IIA (21 cases), II B (18 cases), and III (14 cases), respectively. After adjusting the change in BCVA according to baseline BCVA, ß coefficient was -6.012 letters (p=0.025) in stage IIB and -9.762 letters (p=0.003) in stage III vs stage IIA. Four cases had a retinal pigment epithelium tear after injection of ranibizumab.

Conclusions: Patients in stage II without PED have a better visual and anatomic evolution than patients in stage II with PED and stage III.

MeSH terms

  • Aged, 80 and over
  • Angiogenesis Inhibitors / administration & dosage*
  • Angiogenesis Inhibitors / therapeutic use
  • Antibodies, Monoclonal, Humanized / administration & dosage*
  • Antibodies, Monoclonal, Humanized / therapeutic use
  • Female
  • Fluorescein Angiography
  • Humans
  • Indocyanine Green
  • Intravitreal Injections
  • Macular Degeneration / classification
  • Macular Degeneration / drug therapy*
  • Macular Degeneration / physiopathology
  • Male
  • Prospective Studies
  • Ranibizumab
  • Retinal Neovascularization / classification
  • Retinal Neovascularization / drug therapy*
  • Retinal Neovascularization / physiopathology
  • Retreatment
  • Tomography, Optical Coherence
  • Treatment Outcome
  • Vascular Endothelial Growth Factor A / antagonists & inhibitors
  • Visual Acuity / physiology*


  • Angiogenesis Inhibitors
  • Antibodies, Monoclonal, Humanized
  • VEGFA protein, human
  • Vascular Endothelial Growth Factor A
  • Indocyanine Green
  • Ranibizumab