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Simona Maria Caprani, Jennifer Cattaneo, Marco Bianchi, Simone Donati, Claudio Azzolini; Non Responder Patients To Ranibizumab Therapy In AMD: Baseline Lesion Characteristics And Visual Function. Invest. Ophthalmol. Vis. Sci. 2012;53(14):2028.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate morphological and functional characteristics of exudative AMD in patients non responders to IntraVitreal Ranibizumab (IVR).
In this retrospective study we included 85 eyes of 85 consecutive patients (mean age 74,6± 6,5) treated for active CNV in AMD. All patients underwent a loading dose of 3 IVR (2.3 mg/0.23ml), one every 30 days. We divided patients into three groups according to visual acuity variation as result parameter: Group 1 Responders (R, 23 patients) with a visual acuity (VA) increase more than 1 line, Group 2 Stable (S, 43 patients) and group 3 Non Responders (NR, 19 patients) with a loss of VA more than 1 line. At baseline and at month 4 we studied on each group different responsivity parameters: macular thickness and subretinal fluid on OCT examination, lesion morphology and leakage on fluorescein angiography.
In Group 1 we found at baseline a mean VA of 0.44±0.19logMAR, macular thickness (MT) of 407,04±167,80µm and mean lesion size (LS) of 5,51±4,21mm2; 3 patients presented a significative subretinal haemorrhage (SSH); no Pigment Epitelium Detachment (PED) was detected. At month 4 mean VA was 0.27±0.15LogMAR, MT 201,74±89,68µm and LS 3,91±3,63mm2. In Group 2 baseline mean VA was 0.43±0.23logMAR, MT 368,48±143,88µm and LS 7,46±5,49mm2; 12 patients presented a PED and 2 a SSH. At month 4 mean VA was 0.43±0.23logMAR, MT 268,33±151,83µm and LS 6,92±4,08mm2. In Group 3 mean VA was 0.33±0.17logMAR; MT 331,18±109,75µm and LS 9,74±9,03mm2; 2 patients had a SSH and none a PED. At month 4 mean VA was 0.53±0.19 MT 259,41±110,08µm and LS 10,08±9,85mm2.
Our study showed that the efficacy of IVR primary depends on initial lesion size: NR and S Groups presented a significative larger lesion size than the R group. OCT analysis showed that the presence of intraretinal edema didn’t represent a worsening parameter; in all groups we appreciated a significative reduction of macular thickness after 3 IVR. Finally we didn’t find a significative role of VA as predictive parameter of responsivity to ranibizumab treatment: as functional parameter it depends on the evolution of morphology and activity of the lesion.
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