Abstract
Purpose:
To assess the efficacy and safety of intravitreal ranibizumab for the treatment of new onset inflammatory and idiopathic choroidal neovascularization (CNV).
Methods:
Single-centre prospective case series study. Patients presenting with new onset CNV associated with either posterior segment intraocular inflammation or as isolated inflammatory CNV were included. Monthly intravitreal ranibizumab (0.5mg in 0.05ml) injections for 3 months were administered to all the subjects. Thereafter, re-treatment was based on clinical evidence of persisting activity. Patients were reviewed on a monthly basis for a total of 13 visits. Optical coherence tomography (OCT) and best corrected visual acuity (BCVA) were performed at every visit. Fundus fluorescein angiography was performed at months 0, 4, 12, and as required at other visits. The primary outcome measure was the proportion of patients with less than 15 letters of BCVA loss from baseline at months 4 and 12. Descriptive analysis and Wilcoxon non-parametric test were performed for analysis. A p-value <0.05 was considered as statistically significant.
Results:
Fifteen patients, 10 females (66.7%) with a mean age of 48.8 (range 24-85) years were included in the study. All the patients completed 1 year follow-up. There were 6 cases of idiopathic CNV (40%) and 9 cases (60%) associated with posterior segment intraocular inflammation, among them the most common pathology was punctate inner choroidopathy (in 3 cases, 20%). The mean number of injections was 4.33 (range 3-7) injections. A total of 6 patients (40%) did not need any further injection after the loading dose. No patient had a loss of visual acuity greater than 15 letters during the follow-up. There was a statistically significant difference in the BCVA at month 4 (p=0.001) and at month 12 (p=0.001) compared with baseline. The mean gain in BCVA at month 4 compared with baseline was 20 ± 15.36 letters (mean ± SD), and at month 12 was 21 ± 16.97 letters. There was a statistically significant difference in the mean central macular thickness at baseline vs month 4 (p=0.003) and month 12 (p=0.001).
Conclusions:
Ranibizumab alone is an effective treatment of new onset inflammatory and idiopathic CNV, with good visual outcomes.