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Christoph R. Clemens, Florian Alten, Carolin Milojcic, Eter Nicole; Morphologic Changes In Pigment Epithelial Detachment After Ranibizumab Treatment Assessed By Spectral Domain Oct, Fundus Autofluorescence, Fluorescein And Icg Angiography: Six-month Results Of A Prospective Randomized Study. Invest. Ophthalmol. Vis. Sci. 2011;52(14):1658.
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To report the effect of intravitreal injections of ranibizumab in the treatment of pigment epithelial detachment (PED) secondary to age-related macular degeneration (AMD)
In this prospective investigator sponsored trial, 15 patients with PED associated with AMD received monthly injections of 0,5mg ranibizumab. Baseline and monthly ophthalmic evaluation consisted of visual acuity (VA) measurement using ETDRS charts, and imaging with optical coherence tomography volume scans. Fluorescein angiography (FA) and indocyanin green angiography (ICG) were performed at baseline and every 3 months during follow-up
The median age of the entire cohort was 70.5 (+/-5.6) years. Mean ETDRS VA remained stable at the 6-month follow up 56.1 +/-14.6 letters score at baseline, 58.6 +/-15.7 letters score at 6 months, (P=0.64). Mean central PED thickness decreased from 624.7 +/- 350.8 µm at baseline to 332.5 +/- 158 µm at the 6-month follow up (P= 0.005). Subretinal fluid (SRF) disappeared completely in 8 eyes (53.3%), 6 eyes (40%) showed a decrease in SRF, and 1 eye developed an increase in SRF. Of the 8 eyes with complete resolution of SRF, 4 patients had an improvement in VA of 17.5 +/-12.1 letters, while the eye with increased SRF experienced a reduction in VA of 16 letters. At baseline OCT showed both, a hyperreflective mass and an optically empty space underneath the RPE in 11 eyes. The hyperreflective mass correlated with inhomogeneous hyperfluorescence seen on FLA, whereas the optically empty space on OCT correlated with a homogeneous pooling on FLA. A complete regression of the optically empty space occurred after 6 injections in 10 patients. The hyperreflective mass beneath the PED flattened in 9 patients along with a distinct decrease in hyperfluorescence turning into a freckled appearance on FLA. 3 eyes with the highest PED in the cohort 1090.7 +/-146.8 µm experienced an RPE tear already after the first (2 eyes) and second injection (1 eye) respectively
In this prospective study, a significant reduction of the PED thickness, SRF and reduction in angiographic pooling was found after monthly treatment with ranibizumab for serous PED due to age-related macular degeneration. Although mean VA remained stable, patients might benefit from a decrease in PED hight regarding the risk of RPE tear
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