Abstract
BackgroundThe effects of intravitreal ranibizumab (IVR) against exudative age-related macular degeneration (AMD) may be different associated with the lesion phenotype. This study was conducted to compare the outcomes of IVR between two different phenotypes of exudative AMD: typical neovascular AMD (tAMD) and polypoidal choroidal vasculopathy (PCV).MethodsThis is a retrospective cohort study of 54 eyes from 54 subfoveal exudative AMD patients (tAMD 24, PCV 30 eyes). Three consecutive IVR treatments (0.5 mg) were performed every month, followed by re-injections as needed. Change in the best-corrected visual acuity (BCVA) and central retinal thickness (CRT) were then compared between the tAMD and PCV groups over 12 months of follow-up.ResultsThe mean BCVA was significantly improved (-0.11 logMAR units) at month 3 after the initial IVR (p <0 .001, Wilcoxon signed-rank test), and was sustained up to 12 months in all AMD patients (p =0.02). In the subgroup analysis, the tAMD group showed a significant improvement in their mean BCVA (-0.06, -0.17, -0.15 and -0.16 logMAR units at 1, 3, 6 and 12 months, respectively), but there was only a slight but non-significant improvement in the PCV group. The improvement in the BCVA was significantly greater in the tAMD group than in the PCV group (p = 0.043, repeated measures ANOVA) over 12 months. Both phenotypes showed significant improvements in the CRT during 12 months after the initial IVR.ConclusionsIVR is an effective therapy for tAMD and PCV in the BCVA improvement in Japanese patients over 12 months of follow-up. The phenotype of tAMD showed a significantly better outcome with IVR than PCV in terms of BCVA improvement.
Highlights
The effects of intravitreal ranibizumab (IVR) against exudative age-related macular degeneration (AMD) may be different associated with the lesion phenotype
The typical neovascular AMD (tAMD) group showed a significant improvement in their mean best-corrected visual acuity (BCVA) compared to baseline (-0.06, -0.17, -0.15 and -0.16 logarithm of the minimum angle of resolution (logMAR) units at 1, 3, 6 and 12 months, respectively) (Figure 1 and Table 2)
The amplitude of the BCVA improvement was compared between tAMD and polypoidal choroidal vasculopathy (PCV) at each time-point measured, which showed that tAMD achieved a significantly greater visual improvement than PCV at 3 M after the initial treatment (p = 0.43 at 1 M, p = 0.036 at 3 M, p = 0.066 at 6 M and p = 0.11 at 12 M)
Summary
We first compared the gender, age, BCVA, greatest linear dimension (GLD), central retinal thickness (CRT), history of smoking and previous PDT therapy, presence of subretinal hemorrhage, serous retinal detachment, macular edema, retinal pigment epithelial detachment, subretinal fibrosis, hypertension and diabetes mellitus, and body mass index (BMI) at baseline between the tAMD and PCV groups. To evaluate the factors useful for predicting those patients whose BCVA at 12 months after the initial IVR were improved over the baseline BCVA, multivariate logistic regression analyses were performed using explanatory variables including gender, age, baseline BCVA, baseline GLD, baseline CRT, the number of previous PDT, history of smoking, presence of hypertension and diabetes mellitus, BMI and lesion phenotype (tAMD or PCV). P values of 0.05 or less were considered to be statistically significant
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