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T. Golisch, J. Robinson, J. Prenner, D. Roth; Response of Eyes With Exudative Age-Related Macular Degeneration and Significant Blood to Lucentis. Invest. Ophthalmol. Vis. Sci. 2008;49(13):345.
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To examine the efficacy of Ranibizumab in the treatment of eyes with significant hemorrhage and choroidal neovascularization from exudative age-related macular degeneration (AMD).
Retrospective review of a consecutive series of 30 eyes of 30 patients who received monotherapy with intravitreal injection of Ranibizumab to treat exudative AMD. All eyes had significant hemorrhage (>50% of the choroidal neovascular complex) in the macula on initial presentation. All patients had at least three injections and at least 18 weeks of follow up (average=24 weeks). All eyes had baseline and subsequent angiographic imaging performed allowing for photographic documentation of the change in the amount of blood present at 18 weeks and/or the final examination of the study. The amount of blood resolution and level of visual acuity at the end of week 18 (entire cohort) and at the last visit (subsets of the cohort) were recorded.
The study cohort presented with blood that on average comprised 77.7% of the total lesion size (range 50-100%). The average lesion size was 7.2 disk areas (range 1.5-21). After three injections, the blood on average comprised 10.8% of the total lesion size (range 0-50%). A subset of patients received one (n=26) or two (n=28) additional injections. The cohort that continued therapy demonstrated additional blood resorption, with blood comprising 4.8% and 3.5% of the lesion respectively after four and five injections. Average visual acuity at the time of submacular hemorrhage was 20/200-1 (range 20/32-2 - 1/200). Average visual acuity improved to 20/160+1 (range 20/25+2 - 1/200) after three injections. In the subset receiving additional injections, visual acuity improved to 20/125-3 (range 20/25+1 - 1/200) and 20/125+1 (range 20/25-1 - 3/200) after injections four and five, respectively. Twenty-six eyes (86.7%) were responders (loss of less than three lines of vision), 73.3% of eyes (n=22) had no loss in visual acuity, and 23.3% (n=7) gained three or more lines of vision.
Eyes with lesions comprised of greater than 50% blood are typically not included in clinical trials for AMD, as prognosis in these eyes has traditionally been considered worse than in eyes without significant hemorrhage. In this cohort, eyes responded well in terms of resorption of blood and improvement in visual acuity. Aggressive treatment of these eyes may be warranted with anti-VEGF agents, as the prognosis seems better than might be expected.
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