Abstract
Purpose. To evaluate the early response to intravitreal ranibizumab (IVR) in two different phenotypes of age-related macular degenerations (AMD): typical neovascular AMD (tAMD) and polypoidal choroidal vasculopathy (PCV). Methods. Sixty eyes from 60 patients (tAMD 28, PCV 32 eyes) were recruited. Three consecutive IVR treatments (0.5 mg) were performed every month. Change in the best-corrected visual acuity (BCVA) and central retinal thickness (CRT) was then compared between the tAMD and PCV groups. Results. The mean BCVA logMAR was significantly improved at month 1 and month 3 after the initial IVR in the tAMD group, but there was no change in the PCV group. Both phenotypes showed significant improvements in the CRT during the 3 months after the initial IVR. There were no significant differences in the improvements of the CRT in the tAMD versus the PCV group. In the stepwise analysis, a worse pretreatment BCVA and tAMD lesions were significantly beneficial for a greater improvement of BCVA at 3 months after the initial IVR. Conclusions. The phenotype of tAMD showed a significantly better early response to IVR than PCV in terms of BCVA improvement.
Highlights
The intravitreal injection of ranibizumab (IVR) is currently the treatment of choice for subfoveal choroidal neovascularization (CNV) due to age-related macular degeneration (AMD), a leading cause of central visual loss in the elderly in industrialized countries [1, 2]
Since the early response to intravitreal ranibizumab (IVR) is known to be achieved within 3 months using monthly IVRs, we focused on the comparison between the effects of IVR in typical neovascular AMD (tAMD) and polypoidal choroidal vasculopathy (PCV) during this term
In the time course analysis, the best-corrected visual acuity (BCVA) at 1 month and 3 months after the initial IVR was significantly improved as compared with the baseline BCVA in the tAMD group (P = .0084 and P = .0008, resp., Wilcoxon’s signed-rank test)
Summary
The intravitreal injection of ranibizumab (IVR) is currently the treatment of choice for subfoveal choroidal neovascularization (CNV) due to age-related macular degeneration (AMD), a leading cause of central visual loss in the elderly in industrialized countries [1, 2]. The efficacy of IVR has not been investigated well for exudative AMD in the Japanese population. A recent report described a good response to intravitreous bevacizumab in Japanese AMD patients with classic CNV lesions, but there was limited efficacy in those with occult CNV lesion [5]. We hypothesized that those results might be attributed to the proportion of AMD subtypes in the Japanese population, which includes polypoidal choroidal vasculopathy (PCV) as the major phenotype of exudative AMD [6], and the effects of antivascular endothelial growth factor (VEGF) therapy for PCV may differ from those for typical neovascular AMD (tAMD). To our knowledge, no comparative studies have been published on the effectiveness of IVR associated with the different phenotypes of AMD
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