ABSTRACT
PURPOSE: The purpose of this study was to assess long-term functional and structural retinal changes in patients with neovascular age-related macular degeneration treated with intravitreal 0.5 mg ranibizumab. METHODS: Eighteen patients with neovascular age-related macular degeneration have been evaluated in this retrospective 24-month follow-up study. All patients have been treated with 3 injections of 0.5 mg ranibizumab 1 month apart and retreated according to predefined criteria. At baseline, all patients were subjected to visual acuity, fluorescein angiography, MP1 microperimetry, and Stratus optical coherence tomography. Although visual acuity and optical coherence tomography were repeated 28 +/- 2 days after each injection, MP1 was performed at 6, 12, and 24 months. RESULTS: Seventeen of 18 and 14 of 18 patients completed 12 and 24 months of follow-up, respectively. Mean retinal sensitivity significantly improved from 3.89 +/- 3.0 dB to 7.33 +/- 4.11 dB at 24 months (P = 0.024). Mean visual acuity improved from 48.67 +/- 8.59 to 59.17 +/- 16.45 at 24 months (P = 0.049). Visual acuity improved to >or=15 letters in 33.3% (6 of 18) of patients and <15 letters in 44.4% (8 of 18); 22.2% (4 of 18) of patients lost <15 letters at 24 months. Five of 13 patients (38.5%) with either an instable or relatively instable fixation at baseline showed improvement of fixation stability at 24 months. Central retinal thickness significantly decreased from 310.5 +/- 85.7 to 232.9 +/- 60.1 at 24 months (P = 0.0001). CONCLUSION: Intravitreal injections of 0.5 mg ranibizumab determine progressive improvement of retinal sensitivity until 24 months, although visual acuity levels off after 6 months, suggesting that microperimetry may give additional information about macular function not given by visual acuity alone.
Subject(s)
Angiogenesis Inhibitors/administration & dosage , Antibodies, Monoclonal/administration & dosage , Choroidal Neovascularization/drug therapy , Macular Degeneration/drug therapy , Retina/physiopathology , Aged , Antibodies, Monoclonal, Humanized , Choroidal Neovascularization/physiopathology , Female , Fluorescein Angiography , Humans , Injections , Macular Degeneration/physiopathology , Male , Ranibizumab , Retrospective Studies , Tomography, Optical Coherence , Visual Acuity/physiology , Visual Field Tests , Vitreous BodyABSTRACT
PURPOSE: The purpose of this study was to report functional and morphologic retinal changes after intravitreal injections of 0.5 mg ranibizumab in patients with myopic neovascular membrane (choroidal neovascularization). METHODS: This is a case review of 11 consecutive patients with myopic choroidal neovascularization who received intravitreal injections of ranibizumab at monthly intervals. Serial changes in best-corrected visual acuity, optical coherence tomography, fluorescein angiography, and microperimetry (Nidek MP1, Nidek, Padova, Italy) are presented. RESULTS: Mean baseline best-corrected visual acuity was 59.82 + or - 17.50 Early Treatment Diabetic Retinopathy Study letters. After a follow-up of 36 weeks, mean visual acuity improved to 66.72 + or - 17.3 with a mean change of 6.91 letters. Mean baseline retinal sensitivity was 6.02 + or - 1.9 dB. After 36 weeks, mean sensitivity improved to 8.3 + or - 2.4 dB with a mean change of 2.3 dB. The fixation stability improved from 45.5% to 72.7%. All patients also had complete resolution of subretinal fluid, mean optical coherence tomography central retinal thickness was reduced from 244.64 + or - 39.3 microm to 191.36 + or - 27.3 microm at 36 weeks, and fluorescein angiography at 36 weeks showed absence of leakage in all patients. CONCLUSION: Intravitreal ranibizumab injections seemed to positively influence retinal functional status in patients with myopic choroidal neovascularization.
Subject(s)
Angiogenesis Inhibitors/administration & dosage , Antibodies, Monoclonal/administration & dosage , Choroidal Neovascularization/drug therapy , Choroidal Neovascularization/physiopathology , Myopia, Degenerative/complications , Retina/physiopathology , Adult , Aged , Antibodies, Monoclonal, Humanized , Choroidal Neovascularization/etiology , Female , Fluorescein Angiography , Follow-Up Studies , Humans , Injections , Male , Middle Aged , Ranibizumab , Retrospective Studies , Tomography, Optical Coherence , Visual Acuity/physiology , Visual Field Tests , Vitreous BodyABSTRACT
PURPOSE: To evaluate psychophysical and electrophysiologic responses in eyes with early age-related macular degeneration (AMD) without a decrease in visual acuity and with or without late AMD in the fellow eye. METHODS: Fifteen patients (mean age: 67.9 +/- 7.20 years) with early AMD in both eyes (AMD1 group, 15 eyes) and 15 patients (mean age: 71.40 +/- 7.06 years) with early AMD in one eye and late AMD in the fellow eye (AMD2 group, 15 eyes) were enrolled. They were compared to 15 age-similar normal control subjects. LogMAR visual acuity (VA), macular sensitivity by MP-1 microperimetry, and multifocal electroretinograms (mfERG) were assessed in control, AMD1, and AMD2 eyes. mfERG response amplitude density (RAD, nV/deg2) of the N1-P1 component of first order binary kernels was measured. RESULTS: When compared to controls, AMD1 and AMD2 eyes showed a significant (analysis of variance, P < 0.01) decrease in MP-1 microperimetry assessed in the 0-2.5 and 2.5-5 degrees of the macula, significantly correlated (Pearson test, P < 0.01) to the corresponding significant decrease (P < 0.01) in mfERG N1-P1 RADs assessed in the 0-2.5 and 2.5-5 degrees. In AMD1 and AMD2 eyes, VA and mfERG N1-P1 RADs assessed in the 5-20 degrees were similar (P > 0.01) to controls. VA, MP-1, and mfERG values were not significantly different in AMD1 and AMD2 eyes. CONCLUSION: In eyes with early AMD there is a dysfunction of preganglionic elements in the central 0-5 retinal degrees detectable by mfERG or MP-1 microperimetry. This impairment is not further influenced by the presence of late AMD in the fellow eye.