First Author: S.Crespo Millas SPAIN
Co Author(s): L. Lima Modino C. Blando Labrandero L. Manzanas Leal J. Alonso De La Fuente M. Ramoa Osorio S. Sanchez Tabernero
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Anti-vascular endothelial growth factor injection is the mainstay for treating non-vascular age-related macular degeneration (AMD). Previous studies have shown that Pigment epithelium detachments (PEDs) other tomographic changes are biomarkers of poor response to anti-VEGF therapy. Herein, we identify in a subset of patients whose eyes with neovascular AMD were previously treated with ranibizumab.
This is a retrospective decriptive, observational case series study in neovascular AMD patients treated with intravitreal injections of ranibizumab following a pro re nata (PRN) regimen after a loading phase of three monthly injections and treated with at least 10 injections of intravitreal ranibizumab and incomplete response to treatment and in which switching to aflibercept was considered. Best corrected visula acuity (BCVA), ocular fundus and quatitative and qualitative tomographic changes such as intraretinal fluid , intraretinal cyst, hyperreflective foci and PEDs were examined at the time the decision to change treatment was made. This study has been aproved by the technical comittee of the HCUV.
51 patients were included in the study. 51% were men. 52.9% were phakic and 3.9% were under glaucoma treatment. Type 1 CNV was detected in 51.1% and 47.1% were type 2. PED was present in 72.5% of the patients at the beining and in 78% at the end. Mean follow up treatment was 40.08 (SD 25.96) months and the mean number of intravitreal injections during the follow up period was 11.16 (SD 6.843). BCVA was mantained although there were not significant improvements and was 0.46 LogMAR (SD 0.28). All eyes remained with activity besides treatment. 72% had hyperreflective foci, 52% intraretinal fluid and 92% subretinal fluid. Central fibrosis was present in 26% and atrophy progressed in 16%.
Morphologic tomographic parameters may be associated with the response to ranibizumab therapy in neovascular AMD. Specific alterations suchs as PEDs, hyperreflective foci or the persistence of intraretinal and subretinal fluid are significantly influencing the potential for visual gain.