Therapeutic efficacy and significance of intravitreal injection of ranibizumab for age-related macular degeneration with subfoveal scarring and active lesion

Abstract

Background Intravitreal injection of ranibizumab is a primary approach to the treatment of wet age-related macular degeneration (wAMD), but whether it is necessary for wAMD with subfoveal scarring and active lesion to receive the intravitreal injection of ranibizumab is in dispute. Objective This study was to evaluate the possible therapeutic effect of intravitreal injection of ranibizumab on wAMD with subfoveal scarring and active lesion. Methods The clinical data of the patients with wAMD with subfoveal scarring and active lesion were retrospectively analyzed, including 89 eyes of 89 cases who received diagnoses and treatments in Second Hospital of Yunnan Province from February 2013 to May 2015.Sixty-eight patients who received intravitreal injections of ranibizumab were treated group, and 21 patients who received clinical observations only served as the untreated group.Intravitreal injection of ranibizumab was carried out following the 3+ prn principle, and all of the patients were followed-up for 6-24 months.Best corrected visual acuity (BCVA) of the patients were examined with ETDRS chart.The fundus findings was examined by fundus color photography and fundus fluoresceinangiography (FFA). The subjective assessment of visual improvements was obtained from each patient, and the recession of retinal active lesions was assessed by OCT, including the absorbing state of subretinal fluid, the change of central retinal thickness (CRT) and subfoveal scarring. Results The mean injection times were (4.1±1.2) for each eye.The BCVA at the end of following-up was evidently improved in both groups, and no significant difference was found among various time points (P>0.05). However, the patient rate of BCVA improvement was 69.12% in the treated group, which was signnificantly higher than 28.58% of the untreated group (P=0.016). In the treated group, subretinal fluid was gradually absorbed in all eyes in the treating duration, however, in the untreated group, the fluid was completely absorbed in 7 eyes, unchanged in 8 eyes and increased in 6 eyes.The CRT reduced by (220.16±34.76)μm in treated group, and that in the untreated group was (101.56±31.59)μm, showing significant difference between them (P=0.004). The patient rate of perceived improvement of vision was 91.12% and 42.85% in the treated group and untreated group respectively, with significant difference between the two groups (P=0.008). Conclusions Intravitreal injection of ranibizumab can make active lesion recess in end-stage wAMD with subfoveal scarring and active lesion and improve the life quality of the patients. Key words: Ranibizumab; Wet macular degeneration/complications; Cicatrix/surgery; Antibodies, monoclonal, humanized; Tomography, optical coherence; Visual acuity; Intravitreal injections; Retrospective studied