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Florian Sulzbacher, Christopher G. Kiss, Marion Funk, Stefan Eisenkoelbl, Marion R. Munk, Stefan Sacu, Ursula Schmidt-Erfurth; Functional Treatment Response In Neovascular Age-related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2011;52(14):2900.
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To evaluate the functional treatment response after ranibizumab loading dose in patients with neovascular age-related macular degeneration (nAMD) in relation to the initial SD-OCT finding.
Nineteen eyes showing untreated nAMD were examined with the Heidelberg Spectralis-OCT (SD-OCT) and the NIDEK MP-1 microperimetry (MP) at baseline and after 3 monthly injections of ranibizumab. The fundusphoto (FP) of the MP was exactly matched with the infrared+OCT image of the SD-OCT using virtualDub (Ver.1.8.6) and Paint.NET(Ver. 3.36) software.Each test point of light sensitivity in the FP was transmitted to the corresponding location on SD-OCT using Image J software and subsequently the microperimetric results were evaluated with respect to the following OCT-findings: neovascular complex (NVC), pigment epithelium detachment (PED), subretinal fluid (SRF), intraretinal fluid (IRF) and cysts at baseline and after 3 monthly injections.
In untreated nAMD median retinal sensitivity revealed 0dB [quartiles: 0dB; 3dB] at sites over a NVC, 2,5dB [0dB; 6dB] at sites over a serous PED, 2dB [0dB; 7dB] at sites over a fibrovascular PED, 3dB [0dB; 7dB] at sites over IRF, 5dB [0dB; 11dB] at sites over SRF and 0,5dB [0dB; 3dB] at sites over cysts. After 3 monthly ranibizumab injections locations of NVC recovered in 51% with a median function gain of 5dB [2dB; 11dB], 49% developed a fibrosis with a median functional response of 0dB [0dB; 7dB]. SRF recovered in 92% and was associated with a median functional gain of 4dB [1dB; 11dB], whereas IRF recovered in 80% with a median gain of 7dB [3dB; 9dB]. Cysts disappeared in 93% with a median functional gain of 1,5dB [0dB; 6dB]. A serous PED flattened to normal retinal configuration in 78% and showed a median functional increase of 5dB [2B; 8dB], in 22% of a decreasing serous PED a median function gain of similar values of 5dB [0,5B; 12dB] was assessed. A fibrovascular PED flattened to normal retinal configuration in 31% and showed a median functional gain of 2dB [-0,5B; 4dB], in 69% a fibrovascular PED decreased and showed a median function gain of 3dB [0B; 4dB].
The initial SD-OCT findings provide useful information about the possible functional treatment response in nAMD. The most distinctive functional benefit after 3 monthly ranibizumab injections was observed at sites of fluid, followed by serous and fibrovascular PED. Sites of an initial NVC show a marked functional benefit in every other case, whereas the other half develops fibrosis without functional response.
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