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Ugo Introini, Giuseppe Casalino, Ana Torres Gimeno, Fabrizio Scotti, Silvia M. Giatsidis, Francesco Bandello; Intravitreal Ranibizumab And Exudative AMD Subtypes: Results In A Clinical Setting. Invest. Ophthalmol. Vis. Sci. 2012;53(14):859.
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to compare functional outcome of patients with choroidal neovascularization (CNV) or retinal angiomatous proliferation (RAP) secondary to age-related macular degeneration (AMD) treated with intravitreal ranibizumab in a clinical setting.
we reviewed the medical records of consecutive patients that received three initial monthly injections of ranibizumab and thereafter underwent monthly controls with treatment as needed (PRN) and completed 1-year follow-up. Baseline examination included best-corrected visual acuity (BCVA), fundus biomicroscopy, Spectral-Domain optical coherence tomography (SD-OCT), fluorescein angiography and indocyanine green angiography. Primary treatment outcome measure included changes in mean BCVA, expressed as a logarithm of the minimum angle of resolution (logMAR). Secondary treatment outcome measure showed changes in mean central retinal thickness (CRT).
87 eyes of 83 consecutive patients were included. Mean baseline logMAR BCVA was 0.34±0.19 in the CNV group and 0.37±0.25 in the RAP group, ranging between 0.70 and 0.00 logMAR (20/100 - 20/20) in accordance with local rules. Eyes with CNV (58 eyes) presented predominantly classic (PC, 11 eyes); minimally classic (MC, 10 eyes) and occult with no classic (ONC, 37 eyes) subtypes. The RAP group (29 eyes) included eight eyes with stage I, eight eyes with stage IIA (without retinal pigment epithelial detachment-PED), and thirteen eyes with stage IIB (with PED). Among CNVs, baseline and month 12 mean logMAR BCVA were respectively 0.41±0.24 and 0.37±0.19 for PC; 0.33±0.16 and 0.37±0.21 in MC; 0.33±0.19 and 0.36±0.25 in ONC. In the RAP group, baseline and month 12 mean logMAR BCVA were respectively 0.23±0.21 and 0.22±0.17 for stage I; 0.32±0.18 and 0.20±0.05 for stage IIA; 0.49±0.24 and 0.62±0.39 for stage IIB.
in our sample of patients with exudative AMD, a subgroup analysis of newvessels is a critical factor in the varying outcome in ranibizumab treatment. Retinal angiomatous proliferations, although considered lesions with a poor prognosis, showed in stages I and IIA, encouraging functional response to ranibizumab compared to MC and ONC CNVs. On the contrary, the presence of a RAP with PED (stage IIB) worsened the functional outcome. Further studies are mandatory.
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