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D. Y. Rhee, S. J. Yoon, T. W. Wiegand, A. H. Rogers, C. R. Baumal, J. S. Duker, E. Reichel; Comparison of a Single Injection Versus Multiple Injections of Intravitreal Ranibizumab (Lucentis) for Choroidal Neovascularization Associated With Age-Related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2007;48(13):4937.
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To evaluate the efficacy of a single injection compared to multiple injections of intravitreal ranibizumab (Lucentis) for choroidal neovascularization (CNV) in age-related macular degeneration (AMD).
A retrospective, non-randomized, interventional case series was conducted in 15 consecutive eyes of 14 patients with new subfoveal CNV associated with AMD between July 2006 and September 2006. Exclusion criteria included previous treatment for CNV, visual acuity of count fingers or worse, or a disciform scar. Patients received either a single injection of ranibizumab (0.5 mg in 0.05 ml) or multiple injections of ranibizumab. The need for re-treatment was determined after clinical assessment and was based upon best corrected visual acuity (BCVA) and optical coherence tomography (OCT) imaging of the macula.
6 of 15 eyes received only one injection. 5 of these 6 eyes were noted to have classic CNV on fluorescein angiography. Average initial foveal OCT thickness and BCVA was 290 microns and 20/96 (logMAR=0.68), respectively. Post-treatment mean OCT thickness and BCVA was 242 microns (paired t-test, p=0.0013) and 20/72 (logMAR= 0.56, p=0.2357), respectively, with a mean follow-up of 85 days. 9 of 15 eyes received multiple injections (mean=2.4). Average initial foveal OCT thickness and BCVA of the multiple-injection group was 318 microns and 20/78 (logMAR=0.60), respectively. Post-treatment mean OCT thickness and BCVA was 224 microns (paired t-test, p=0.0223) and 20/63 (logMAR= 0.50, p=0.4749), respectively, with a mean follow-up of 75 days.
Patients treated with a single injection and those with multiple injections of ranibizumab experienced a significant average decrease in central foveal thickness and demonstrated a trend towards improvement in visual acuity, although this was not statistically significant. There was no significant difference between the final OCT measurements or the visual acuity between the two groups. These results suggest that there are patients who have subfoveal CNV who may improve after a single injection of intravitreal ranibizumab and the effect may be sustained over time. Longer follow-up and larger numbers of patients are needed to confirm these results.
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