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Refractory subretinal fluid in patients with neovascular AMD treated with intravitreal ranizubimab- functional outcome

Session Details

Session Title: AMD I

Session Date/Time: Thursday 26/09/2013 | 08:30-10:30

Paper Time: 09:34

Venue: Hall 1 (Level 2)

First Author: A.Ambresin SWITZERLAND

Co Author(s):    L. Jang   C. Gianniou   I. Mantel   -. -     

Abstract Details


Despite monthly intravitreal injections of ranibizumab, some eyes with neovascular age-related macular degeneration (nAMD) may present refractory subretinal fluid (SRF). The study aimed to investigate the functional outcome, in order to describe the prognosis and estimate the usefulness of treatment in these cases.


Retrospective chart review


Eyes with nAMD and treated with intravitreal ranibizumab were included if they presented SRF at each visit (1 month after injection) during the first 12 months, motivating monthly retreatment (real life number of injections 10-12 during first year). Data were evaluated for the mean visual acuity (VA) change over time, and for mean central retinal thickness on OCT. Time until complete absorption of SRF was recorded, and the angiographic type of underlying choroidal neovascularisation (CNV) was analysed.


Inclusion criteria were met by 34 patients with 34 eyes. The average age was 80 years (range 64 to 98). Mean follow-up duration was 29.1 months (range 12-39 months). Mean number of treatments was 11.6 in the first year, and 26.9 over follow-up. 15 eyes (44%) presented occult, 8 eyes (24%) classical, 8 eyes (24%) minimally classic CNV. 3 eyes (8%) presented a RAP lesion. The refractory SRF was located subfoveally in 21 eyes (62%), extrafoveally in 8 eyes (24%), and variably sub-/extrafoveally in 5 eyes (15%). In 28 eyes (82%) the SRF persisted over the entire follow-up (mean 29.7 months, range 12-39 months). In 6 eyes absorption of SRF was found after a mean of 25 months (range 20-38 months) Mean baseline VA was 67.2 ETDRS letters. It increased by 8.4, 5.1 and 6.5 letters by month 12, 24, and 36 respectively (34, 23 and 12 eyes respectively), approximately mirroring mean central retinal thickness change of -54µm, -49µm and -39µm. Eyes with persistent SRF during follow-up showed reduced although stable visual benefit as compared to eyes with SRF absorption during follow-up.


SRF that is refractory to monthly treatment with ranibizumab during at least 12 months still allows maintenance of the visual benefit of treatment. It may occur in any type of CNV lesion, and may absorb under continuous monthly treatment.

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