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Cheryl C. MacGregor, Manju Chandran, Emily Turton, Jincy Jose, Geeta Menon; Low Visual Acuity and their Outcomes with intravitreal Ranibizumab. Invest. Ophthalmol. Vis. Sci. 2011;52(14):1684.
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The development anti-VEGF agents and their treatment effects for wet Age related Macular Degeneration (AMD) has possibly been the most remarkable break-through in Ophthalmology in recent years. However, it has come with a service burden and licensing restrictions. This study was performed to evaluate the visual outcomes in patients with low Visual Acuity (VA) receiving intravitreal Ranibizumab over the course of 12 months. Few studies have examined patients from a low VA baseline and we wanted to correlate our data with other Ranibizumab studies to determine whether this group of patients experienced similar benefits from Ranibizumab and whether these results were sustained. We also wanted to quantify whether there was an improvement or stabilization in vision acuity and average number of injections in a year at our Hospital.
Retrospective review of 49 eyes with AMD and baseline VA of 25 to 35 letters. Inclusion criteria were presence of exudative macular degeneration of all subtypes with less than 50% of the lesion being fibrosed. Treatment involved 3 consecutive injections of Ranibizumab 0.5mg at 4 weekly intervals and then as required for another 9 months. Outcome measures were change in visual acuity (VA) measured by Early Treatment Diabetic Retinopathy Study (ETDRS) charts and central macular thickness (CMT) at baseline and at the end of 54 weeks
Mean age was 78.6 years and had a follow up period of 12 months. Mean visual acuity at baseline was 29.08(±3.8) letters improving to 38.33(±12.6) after 12 months. Mean Central macular thickness (CMT) at baseline was 292.37(±85.4)and decreased to 243.06(±58.8). Mean number of injections was 6.7(±1.9). There was a statistically significant improvement in visual acuity (p<0.01) as well as reduction in thickness (p <.001). 23 out of 49 patients (46.9%) showed a significant improvement in visual acuity while 13 out of 49 patients (26.5%) showed a significant reduction in thickness. Mean number of injections per patient in 12 months was 7 (with a range of 3 to 12 injections)
Intravitreal Ranibizumab injections do lead to an improvement in VA as well reduction in CMT that is sustained in patients with poor vision due to chronic AMD. However, this study has been carried on a small case series and would benefit from an increased sample size.
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