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Therapie der retinalen angiomatösen Proliferation im Stadium III

Intravitreale Ranibizumab-Injektionen

Therapy of stage III retinal angiomatous proliferation

Intravitreal ranibizumab injections

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Zusammenfassung

Die retinale angiomatöse Proliferation (RAP) ist eine Unterform der exsudativen altersabhängigen Makuladegeneration, die sich durch einen intraretinalen Ursprung der Läsionen auszeichnet und eine besonders schlechte Prognose aufweist. In diese retrospektive Fallserie wurden 33 Augen von 33 Patienten mit RAP-Läsionen im Stadium III eingeschlossen und initial mit 3 intravitrealen Eingaben von 0,5 mg Ranibizumab in monatlichen Abständen behandelt. Kriterien für eine Weiterbehandlung waren Visusminderung, frische Blutungen, Restflüssigkeit oder Zunahme der zentralen Netzhautdicke im OCT sowie persistierende Aktivität in der Fluoreszenzangiographie (FLA). Der Nachbeobachtungszeitraum betrug 8 Monate. Der mittlere „best corrected visual acuity“ (BCVA) stieg von logMAR 0,71 zum Ausgangszeitpunkt nicht signifikant auf logMAR 0,67 nach den ersten 3 intravitrealen Behandlungen an und blieb stabil bei logMAR 0,67 nach 8 Monaten. Die mittlere Abnahme der zentralen Netzhautdicke nach 4 Monaten (–90 μm) und nach 8 Monaten (–70 μm) war signifikant. Von den eingeschlossenen Patienten wurden 67% mehrfach wiederbehandelt, die mittlere Frequenz an Reinjektionen betrug 2,27 Injektionen nach 8 Monaten. Die intravitreale Eingabe von Ranibizumab führt bei Patienten mit RAP-Läsionen im Stadium III zu funktioneller und anatomischer Stabilisierung. In den meisten Fällen ist eine wiederholte Behandlung notwendig. Dies untermauert den dringenden Bedarf einer engmaschigen Nachkontrolle.

Abstract

Retinal angiomatous proliferation (RAP) is a subtype of exudative age-related macular degeneration which is characterized by an intraretinal origin of the lesion and a particularly poor prognosis. In this retrospective case study 33 eyes from 33 patients with stage III RAP lesions were included and initially treated with 3 intravitreal injections of 0.5 mg ranibizumab at monthly intervals. Criteria for extended treatment were visual deterioration, fresh bleeding, residual fluid or increase of the central retinal thickness in optical coherence tomography (OCT) as well as persisting activity in fluorescence angiography (FLA). The follow-up period was 8 months. The mean best corrected visual acuity (BCVA) increased insignificantly from logMAR 0.71 at the start of therapy to logMAR 0.67 after the first 3 intravitreal treatment injections and remained stable up to 8 months. The mean decrease of the central retinal thickness after 4 months (-90 µm) and after 8 months (-70 µm) was significant. Of the patients included in the study 67 % were treated repeatedly and the mean frequency of reinjections was 2.27 injections after 8 months. The intravitreal injection of ranibizumab in patients with stage III RAP lesions resulted in functional and anatomical stabilization. In most cases repeated treatment is necessary which underlines the urgent need for close surveillance in follow-up

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Maier, M., Perz, C., Bockmaier, J. et al. Therapie der retinalen angiomatösen Proliferation im Stadium III. Ophthalmologe 110, 1171–1178 (2013). https://doi.org/10.1007/s00347-012-2732-7

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