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Kathy Jao, Devinder Chauhan; Early fluid clearance following intravitreal ranibizumab injection for neovascular age-related macular degeneration. Invest. Ophthalmol. Vis. Sci. 2013;54(15):6272.
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To investigate the early fluid clearance response to intravitreal ranibizumab therapy for neovascular age-related macular degeneration.
A prospective observational study of consecutive patients presenting to a retinal practice with treatment-naïve neovascular age-related macular degeneration (AMD) was conducted between August 2009 and December 2012. Spectral domain optical coherence tomography (SDOCT) images with 5 vertical and 5 horizontal raster scans were taken just prior to the first intravitreal injection of ranibizumab and subsequently 1, 4 and 7 days after the injection. A quantitative segmental manual analysis of all SDOCT images was performed by a masked observer using standard image analysis software. Rates of change in mean cross-sectional area of the total macula (TM), intra-retinal fluid (IRF), sub-retinal compartment (SRC) consisting of sub-retinal fluid (SRF) and sub-retinal tissue (SRT), and retinal pigment epithelial detachment were derived.
Fourteen patients were enrolled, with complete data collected up to one year for eleven. One patient could not be included because subsequent indocyanine-green angiography demonstrated choroidal polypoidal vasculopathy. Two other patients did not attend for all the follow-up assessments within the first 7 days after the injection. Three patterns of early fluid clearance were identified. The first group, consisting of four patients, had a noticeable decrease in IRF and SRF over the first week, of which the majority of change occurred in the IRF compartment. The second group, consisting of five patients, had a noticeable decrease in IRF and SRF over the first week, of which the change was identified in both compartments. The third group, consisting of two patients, had no noticeable decrease in total fluid.
SDOCT imaging affords an opportunity to analyse individuals’ response to intravitreal therapy both quantitatively and qualitatively. The latter, showing that the IRF clears faster than the SRF, is consistent with both bulk fluid flow from the retina towards the choroid and reduced leakage from the retinal circulation. Future studies investigating early fluid clearance responses to intravitreal therapy by quantitative OCT subanalysis may help to predict long-term prognostic outcomes.
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