Gas-mediated vitreomacular adhesion release with intravitral ranibizumab injections for exudative age-related macular degeneration.

Abstract

To evaluate the efficiency of gas-assisted vitreomacular adhesion (VMA) release combined with intravitreal ranibizumab injections for exudative age-related macular degeneration (AMD) patients. This prospective, interventional case series included a total of 23 eyes of 22 patients. The eyes were treated with intravitreal injection of 0.3mL of perfluoropropane (C3F8) gas and concomitant intravitreal ranibizumab injection to stimulate VMA release. After three initial loading injections, additional intravitreal ranibizumab injections were performed pro re nata. Over a 12-month period, monthly examinations were performed for best-corrected visual acuity (BCVA, logMAR; logarithm of the minimum angle resolution), optical coherence tomography, and dilated fundus examinations. After gas injection, 22 eyes (95.7%) showed complete VMA release at 1week. Complete VMA was achieved in all eyes at 2months after VMA release, without serious ocular adverse events except one patient who developed a retinal tear. Mean BCVA was 0.61 ± 0.37 logMAR (20/81 Snellen equivalents) at baseline and 0.46 ± 0.30 logMAR (20/57 Snellen equivalents) at 12months (P = 0.135). Mean central macular thickness was 357.9 ± 128.6μm at baseline and 245.6 ± 60.0μm at 12months (P = 0.188). Mean numbers of intravitreal ranibizumab injections were 4.8 ± 2.4 times during 12months (4 to 8 injections). Gas-assisted VMA release can be used as an efficient alternative for exudative AMD patients with obvious VMA.