First Author: U.Introini ITALY
Co Author(s): G. Casalino F. Bandello 0 0 0 0 0 0 0 0 0
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To compare the functional outcome of different neovascular age-related macular degeneration (nv-AMD) subtypes treated with intravitreal ranibizumab in a routine clinical setting
Non randomized retrospective case series
We reviewed the medical records of 150 eyes of 146 consecutive patients with neovascular AMD who underwent 3 monthly ranibizumab injections (loading phase) followed by a pro-re-nata (PRN) regimen during 2 years of follow-up. Baseline evaluation included fluorescein angiography, indocianine green angiography and spectral-domain optical coherence tomography findings. Mean best-corrected visual acuity (BCVA), central retinal thickness (CRT) and retinal morphology changes were the main study outcome measures considered
31 eyes presented predominantly classic (PC) choroidal neovascularization (CNV), 31 eyes minimally classic (MC) CNV, and 59 eyes occult with no classic (ONC) CNV. 29 eyes presented retinal angiomatous proliferation (RAP), including 8 eyes with stage I, 8 eyes with stage IIA (without retinal pigment epithelial detachment-PED), and 13 eyes with stage IIB (with PED). According to local rules, minimal baseline BCVA was 0.70 LogMAR (range 0.7 - 0.0). Mean LogMAR BCVA did not improve significantly in any of the subgroup NVs during the study. From baseline to month 24 mean LogMAR BCVA changed from 0.41±0.24 to 0.37±0.19 in PC (p=0,3), from 0.33±0.16 to 0.37±0.21 in MC (p=0.7), and from 0.33±0.19 to 0.36±0.25 in ONC (p=0.7); from 0.23±0.21 to 0.22±0.17 for stage I RAP (p=0.8), from 0.32±0.18 to 0.20±0.05 for stage IIA RAP (p=0.3), and from 0.49±0.24 to 0.62±0.39 for stage IIB RAP (p=0.7). From baseline to month 24 mean CRT changed from 322±85μ to 281μ±69μ in CNV group (p=0.19) and from 289μ±70μ to 246±68μ in RAP group (p=0.7). In all, the mean number of injections during the study period was 7.03 (range 3-11). No ocular or systemic side effects were observed during the study period.
High baseline visual acuity and a broad spectrum of neovascular AMD (i.e. 3 CNV subtypes + RAP) are possibly responsible for the overall disappointing outcomes in the current analysis. Interestingly, although considered lesions characterized by poor prognosis, our findings suggest that RAP can show good functional outcomes, if treatment is started early (at stages I and IIA).