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Laura Milner, Claudio Campa, Richard P. Hagan, Malcolm C. Brown, Simon P. Harding; Improvements in Macular Function in Neovascular Age-related Macular Degeneration patients Treated with Ranibizumab. Invest. Ophthalmol. Vis. Sci. 2011;52(14):1681.
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To evaluate macular function changes in patients with neovascular age-related macular degeneration (nAMD) undergoing ranibizumab treatment over a period of 12 months.
Patients with nAMD were recruited into an observational longitudinal study and examined at baseline, 3, 6 and 12 months. The effect of ranibizumab anti-VEGF treatment upon macular function was assessed using multifocal electroretinography (mfERG)(Retiscan, Roland Consult) and microperimetry (MP1)(Nidek). These were compared to the standard outcome measure of refraction protocol best corrected visual acuity (BCVA) measured on ETDRS charts.
14 patients were recruited. Mean mfERG P1 response amplitude from the central hexagon improved from the baseline value of 26.8 nV/deg2 to 47.5 nV/deg2 at 3 months, 42.6 nV/deg2 at 6 months and 38.6 nV/deg2 at 12 months (repeat-measure ANOVA, p=0.021). The mean P1 amplitudes from ring 2 and ring 3 of the mfERG did not change by a clinically significant amount over the 12 month period (ΔR2 < 4 nV/deg2 and ΔR3 < 2.5 nV/deg2). There was no significant change in mean hexagon response latency over the 12 months.Median visual acuity improved from 57.5 ETDRS letters at baseline to 69, 67 and 66 letters at 3, 6 and 12 months respectively (p=0.002). Mean retinal sensitivity inside the central 4degrees improved from 2.8 dB at baseline to 6.7 dB, 5.6 dB and 5.9 dB at 3, 6 and 12 months respectively (p=0.007).
Central retinal function as measured by mfERG and MP1 significantly improved over a 12 month course of ranibizumab therapy and paralleled improvements in BCVA. Some subjects did not respond to treatment and further investigation into mechanisms of response is warranted. Measures of central function other than BCVA should prove useful in measuring treatment effects in future treatment trials.
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