Abstract
Purpose: :
It is now well established that intravitreal Ranibizumab is very effective for treatment of wet age related macular degeneration (AMD) and many patients experience visual improvement. It is uncertain whether, given the same baseline visual acuity, the treatment benefit of intravitreal ranibizumab is the same for a treatment naïve patient as the one who has been previously treated with verteporfin photodynamic therapy (VPDT). The aim of the study is to compare the response of anti VEGF treatment (Ranibizumab) in neovascular AMD in patients who received ranibizumab as second line therapy to patients with similar baseline acuity who received ranibizumab as first line therapy.
Methods: :
The ETDRS visual acuity and central retinal thickness (CRT - stratus OCT) of all patients who underwent intravitreal Ranibizumab therapy between August 2008 and December 2008 were recorded before and after the loading treatment. They were divided into two groups, group 1 - Ranibizumab second line therapy, group 2 - Ranibizumab first line therapy. Only patients with classic component and ETDRS visual acuity (VA) between 73 - 24 letters were included in the study.
Results: :
14 patients in group 1 and 15 patients in group 2 met the inclusion criteria. Five patients (38%) in group 1 and seven (46%) in group 2 had pre treatment VA better than 50 letters. Following treatment, 5 patients (38%) in group 1 had improvement of VA by ≥1line where as 12 (60%) patients in group 2 had improvement of VA ≥ 1 line. The CRT in group 1 improved from 297±82µm to 228±68µm. In group 2, the CRT improved from 266±57µm to 222±38µm.
Conclusions: :
Patients who have failed to respond to VPDT appear to have a lesser visual recovery following treatment with intravitreal anti-VEGF drugs compared to eyes treated with anti-VEGF alone. Patients who have undergone VPDT therapy in the past should be given realistic expectations regarding the outcome of treatment with the anti - VEGF agents.
Keywords: age-related macular degeneration • vascular endothelial growth factor • photodynamic therapy