Abstract
Purpose: :
Spectral Domain (SD) OCT analysis and follow-up after intra-vitreal injections of Ranibizumab in patients with vascular polypoidal choroidopathies (VPC) and evaluation of the changes in the outer retinal layers as predictive of the final result.
Methods: :
Series of 10 caucasian patients affected by VPC, (mean age was 65.2 years, range 51-79 years) were treated with median range 5.2 intra-vitreal injections of Ranibizumab over a period of 12 months. These patients were examined monthly with biomicroscopy, fluorescein and SLO-ICG angiographies and with SD-OCT. Results of treatment were based on functional outcome (visual acuity), on retinal thickness changes and morphological changes of the outer retinal layers. These measures were analysed to evaluate their role in re-injection decision and for potential prognostic factor.
Results: :
In 80% of cases, we detected a marked improvement with significant decrease (greater than 25% and more than 100 µm) of retinal thickness. After 12 months and an average of 5.2 IVT, we observed progress in VA (average gain of 3 lines ETDRS). Nevertheless, the persistence of fibrosis in 40% of cases has been associated with stabilization of VA and an average gain of only 1 line ETDRS.In 90% of patients we detected a major regression of inflammatory signs and exudative reaction (additional dense areas and hyper-reflective dots). After treatment, we noted the persistence of the polyps but without exudative reaction in 40% of cases. Exudative recurrences were frequent (90%), but subsequent intra-vitreal injections were very efficient. In many cases (60%), a fibrotic reaction developed, either minimal but sometimes extensive (30%) and including these polyps.
Conclusions: :
Decompensated VPC can benefit from Ranibizumab treatment. Diagnosis should be obtained at the earliest stage and treatment prolonged for a long period of time to avoid exudative recurrence and residual fibrosis. The presence of inflammatory changes near the polyps is an indication to continue treatment.
Keywords: age-related macular degeneration • choroid • macula/fovea