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R. Radhakrishnan, C. Zatezalo, L. Rangwala, K. Zamecki, F. Esmail, A. Macedo, S. Brodie; Use of Intravitreal Ranibizumab in Patients With Profound Visual Loss. Invest. Ophthalmol. Vis. Sci. 2009;50(13):1589.
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Patients with Wet Age-Related Macular Degeneration with a vision less than 20/320 were excluded from the original ANCHOR and MARINA trials. We explore subjective and objective observations of patients receiving Intravitreal Ranibizumab (Lucentis®) with visual acuities less than or equal to 20/200.
We performed a small, retrospective case study of patients that received intravitreal injection(s) of Ranibizumab in the Veteran’s Administration Health System in Bronx, NY. Patients had a full ophthalmic exam prior to injection, intraocular pressure check one day after the injection, and monthly monitoring of visual acuity, intraocular pressure, and indirect ophthalmoscopy. Fluoroscein angiography and optical coherence tomography were performed at the discretion of the retinal specialist. Patients were surveyed about improvement in their VA, central scotoma and distortion.
Twenty-two male patients (23 eyes) were found to have profound visual loss and were given Ranibizumab (Lucentis®), most often for choroidal neovascularization (70%, n=16 eyes). Fifteen patients surveyed revealed subjective visual improvement in 56% of patients and no change in 38% of patients. The central scotoma improved in 63% of patients, visual distortion improved in 69% of patients, despite 86% of patients continue to show profound visual loss. Vision ranged from 20/200 to counting fingers and patients were followed up ranged from one month to seventeen months.
Subjective visual improvement on Lucentis® was demonstrated in over half of our patients despite poor visual acuity at initiation of treatment. Shrinkage of central scotoma and improvement of central distortion with patient satisfaction may occur even when visual acuity does not improve.
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