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M. M. Maier, N. Feucht, B. Fiore, A. Rathscheck, C. Winkler von Mohrenfels, C. P. Lohmann; Functional and Morphological Outcome After Ranibizumab Upload in the Treatment of Neovascular Age-Related Macular Degeneration in Clinical Routine. Invest. Ophthalmol. Vis. Sci. 2009;50(13):2386.
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To evaluate the functional and morphological effect in clinical routine treatment during upload with ranibizumab (0,5mg) in patients with neovascular age-related macular degeneration (AMD).
In a clinical study 238 patients (238 eyes) with neovascular age-related macular degeneration were treated with three monthly injections of ranibizumab. 151 patients (63,4%) were untreated, 87 patients (36,6%) had prior treatment. Before and one month after the third injection visual acuity, OCT examination and fluorescein angiography (FA) were performed.
We found stabilization of visual acuity in 227 patients (95%), but no statistically significant improvement (VA baseline: 20/63, after 3 months 20/63). OCT examination showed a significant mean reduction of foveal thickness of 22,9µm (Baseline: 277,4µm, after 3 months: 254,4µm ). Fluorescein angiography displayed stabilization of lesion size and a significant reduction of leckage compared to baseline.136 patients (57,1%) needed further therapy after the upload phase. There was no significant correlation between visual acuity and morphological change in OCT or fluorescein angiography. We found no change in choroideal perfusion but 5 RPE-rips.
Intravitreal injection of ranibizumab during the upload phase was well tolerated and safe. In 227 patients (95 %) visual acuity was stabilized. It is unclear why there was no initial improvement like in other studies (MARINA, ANCHOR). Further studies are necessary to evaluate the outcome in clinical routine treatment.
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