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Maria Dimitry, Nitin Jain, Lorraine North, Manju Chandran, Geeta Menon; Is foveal RPE autofluorescence a predictor of visual outcome in wet Age Related Macular Degeneration patients treated with Ranibizumab?. Invest. Ophthalmol. Vis. Sci. 2013;54(15):6266.
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Autofluorescence (AF) images are thought to represent the metabolic turnover of retinal pigment epithelial cells where increased AF may be due to poor outer segment photoreceptor function. Increased foveal AF has been proposed as a poor prognostic factor for visual acuity outcome in wet AMD patients on anti-VEGF therapy. The aim of this study is to evaluate the correlation between AF imaging and visual outcome.
This is a retrospective study of 58 patients and 60 eyes with treatment-naive exudative macular degeneration identified during the 6 months period (Oct 2010 to March 2011). Patients were treated with three standard loading doses of Ranibizumab and followed up monthly with further injections if required. Foveal AF images (Heidelberg Retina Angiograph) were analysed for normal, increased, decreased or increased + decreased AF within a 500 to 1000 microns radius from the fovea at presentation. Best corrected visual acuity (BCVA) was measured at presentation and 12 months follow-up. The non parametric Mann-Whitney U test was used to analyse the data.
At presentation, analysis of AF showed a significant difference in BCVA in eyes with changes on autofluorescence within 500 microns (p=0.039) and 1000 microns (p=0.020). At 12 months, analysis of AF showed no significant difference in BCVA in eyes with changes on autofluorescence within 500 microns (p= 0.08) and 1000 microns (p= 0.079). At presentation and 12 months, comparison of eyes with normal AF and increased AF show no significant difference in visual acuity in 500 microns (0 months p=0.434; 12 months p=0.497) and 1000 microns (0 months p= 0.231; 12 months p= 0.435).
Visual outcomes following treatment of wet age related macular degeneration is multifactorial. A previous suggestion that a change or increase in foveal AF at presentation may affect visual outcome was based on a follow-up period of less than 6 months. At 12 months follow-up, this study shows no significant correlation between changes or increase in AF at presentation and visual outcome.
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