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Y. Qian, W. Sittavarakul, K. Hong, S. M. Lee, N. R. Acharya; Long-Term Outcomes of Ranibizumab for Uveitic Macular Edema and the Effect on Contralateral Eyes. Invest. Ophthalmol. Vis. Sci. 2010;51(13):5115.
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Our previous study on ranibizumab for uveitic macular edema demonstrated a statistically significant improvement in macular edema and visual acuity at 6 months (AJO 2009; 148: 303-309). Here, we report on the 12-month results as well an observed effect on the non-injected contralateral eyes with refractory bilateral cystoid macular edema due to uveitis.
Seven patients with controlled uveitis and longstanding cystoid macular edema were enrolled in a prospective, interventional open-label trial for three monthly injections of 0.5 mg intravitreal ranibizumab for the eye with worse vision, followed by repeat injections based on macular thickness. Baseline best spectacle-corrected visual acuity (BSCVA) and optical coherence tomography were performed for central retinal thickness (CRT) of both eyes monthly.
Of the seven patients enrolled in this study, five patients completed the study at 12 months. From baseline to 6 months, there was improvement of mean BSCVA from 50 letters (20/100) to 63 letters (P=0.03) and improvement of mean CRT from 555µm to 213µm (P=0.03). Between 6 to 12 months, there was little change in BSCVA with a median loss of 2 letters (range -6 to +2 letters, P=0.08). Between 6 to 12 months, the median CRT worsened by 83µm (range 6µm improvement to 502µm worsening, P=0.08). There were three patients with bilateral cystoid macular edema who received unilateral intravitreal injections of ranibizumab. No other treatment changes were made during the study. The contralateral eyes of each of these patients experienced improvement in CRT at 3 months, which was sustained to 12 months in one eye and to 6 months in another eye, but not sustained beyond 3 months in the third eye. At 6 months, the contralateral eyes gained 2, 6, and 1 lines of BSCVA, respectfully. At 12 months, the BSCVA was 1 line gain (2 eyes) to 1 line loss (1 eye). One patient with bilateral neovascularization of the optic nerve had regression of neovascularization in both study and fellow eye at 3 months, which was sustained at 12 months.
Intravitreal ranibizumab in uveitic eyes with refractory macular edema led to an increase in BSCVA which was sustained from months 6 to 12. There was an increase in CRT from months 6 to 12, after most patients stopped receiving injections. Contralateral effect of intravitreal ranibizumab has not been reported. The benefit of reduced cystoid macular edema and improvement in visual acuity observed in contralateral eyes raises questions on the pharmacokinetics of ranibizumab in eyes with uveitis.
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