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Roberto Gallego-Pinazo, Empar Sanz-Marco, Sebastián Martínez-Castillo, Rosa Dolz-Marco, J.Fernando Arévalo, Manuel Díaz-Llopis; Spectral Domain Optical Coherence Tomography Treatment Guidance Of Monthly Follow-up Of Patients With Exudative Age-Related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2012;53(14):6523.
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To analyze the monthly follow-up based on spectral-domain optical coherence tomography (SD-OCT) of patients with exudative age-related macular degeneration (eAMD).
The charts of all the treatment-naïve eyes with eAMD receiving their first ranibizumab injection between October 2008 and May 2009 were retrospectively reviewed. Changes in best-corrected visual acuity (BCVA) and SD-OCT morphometric parameters (central subfield thickness -CST-, cube volume -CV-, average cube thickness -CAT-) were analyzed between baseline and after 48 weeks of follow-up. Patients were stratified according the SD-OCT subtype into 1, 2 and 3 neovascularization (NV). After the initial intravitreal injection of ranibizumab, a monthly follow-up was established in all cases. Further retreatments were performed in the presence of any persistent or recurrent intra or subretinal fluid.
Ninety-six eyes of 96 patients were included; 70 eyes were classified as type 1 NV (72.9%), 16 eyes as type 2 NV (16.7%), and 10 eyes as type 3 NV (10.4%). The mean BCVA improved significantly in all subgroups (p<0.001); CST, RV and CAT decreased significantly in all subgroups (p<0.001). At month 12, only 14 patients (14.6%) showed exudative activity in the SD-OCT: 17.1% of all type 1 NV, and 12.5% of all type 2 NV.A total number of 455 intravitreal injections of ranibizumab were administered to the 96 eyes included: cases with type 1 NV required a mean number of 4.61 injections (range: 1-10); those with type 2 NV required 5.38 (range: 3-10); and those with type 3 NV required 4.6 (range: 1-6). All 96 patients completed the 12-months follow-up, with no relevant side effects registered. Only 29 cases (30.2%) required a full loading phase with 3 initial consecutive injections of ranibizumab (17.1% of eyes with type 1 NV; 87.5% of eyes with type 2 NV; and 30.0% of eyes with type 3 NV).
The visual and anatomic outcomes of patients included in the present study were equivalent to those reported by the "treat and extend" protocols published. An interesting finding was that only 30.2% required a full loading phase with 3 initial consecutive injections of ranibizumab (mainly those with type 2 NV). However, no differences in the final number if injections or the visual and anatomical outcomes were evidenced depending on the SD-OCT type of CNV.
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