Effect Of Intravitreal Ranibizumab Injection Research Articles

Effects of Intravitreal Ranibizumab Injection on Peripheral Retinal Microcirculation and Cytokines in Branch Retinal Vein Occlusion with Macular Edema.

Background and Objectives: To investigate peripheral blood flow in retinal vessels and vessel diameters after intravitreal ranibizumab injection (IRI) and the relationship between these parameters and cytokines in branch retinal vein occlusion (BRVO) with macular edema. Materials and Methods: We assessed relative flow volume (RFV) and the width of the main and branch retinal arteries and veins in the occluded and non-occluded regions before and after IRI in 37 patients with BRVO and macular edema. Measurements were made using laser speckle flowgraphy (LSFG). When performing IRI, we obtained samples of aqueous humor and analyzed them using the suspension array method to evaluate vascular endothelial growth factor (VEGF), placental growth factor (PlGF), platelet-derived growth factor (PDGF)-AA, soluble intercellular adhesion molecule (sICAM)-1, monocyte chemoattractant protein 1 (MCP-1), interleukin (IL)-6, IL-8, and interferon-inducible 10-kDa protein (IP-10). Results: In both retinal regions, before and after IRI, the RFV in the main artery and vein showed a significant correlation with the summed RFV in the respective branch vessels 1 and 2. In the occluded region, the RFV in the main vein was significantly negatively correlated with MCP-1, PDGF-AA, IL-6, and IL-8; the RFV in branch vein 1 was significantly negatively correlated with PlGF, MCP-1, IL-6, and IL-8; PDGF-AA was significantly negatively correlated with the width of the main and branch veins; and the RFVs of the main artery and vein decreased significantly from before to 1 month after IRI. Conclusions: Contrary to expectations, the study found that anti-VEGF therapy does not affect RFV in arteries and veins in patients with BRVO and macular edema. Furthermore, retinal blood flow is poor in patients with high MCP-1, IL-6, and IL-8. Finally, high PDGF-AA may result in smaller venous diameters and reduced retinal blood flow.

Effects of Intravitreal Ranibizumab Injection to Treat Macular Edema due to Central Retinal Vein Occlusion on Choroidal Findings and Functional-Morphological Parameters

Introduction: Little research has examined the effects of anti-vascular endothelial growth factor therapy on subfoveal choroidal thickness (SCT), choroidal blood flow, aqueous flare, and humor levels of growth and inflammatory factors in patients with macular edema due to central retinal vein occlusion (CRVO). Methods: In 58 patients with macular edema due to CRVO treated by intravitreal ranibizumab injection (IRI), we retrospectively assessed best-corrected visual acuity (BCVA, assessed as the logarithm of the minimum angle of resolution [logMAR]), 8 aqueous factors (by suspension array), mean blur rate (MBR; estimated by laser speckle flowgraphy as a measure of choroidal blood flow), aqueous flare (with a laser flare meter), and SCT and central macular thickness (CMT; by optical coherence tomography). Results: After 4 weeks, IRI resulted in a significant improvement in BCVA and CMT and a significant reduction in SCT, choroidal MBR, and aqueous flare. SCT was significantly positively correlated with placental growth factor and significantly negatively correlated with platelet-derived growth factor-AA, and change in SCT was significantly negatively correlated with change in BCVA (logMAR). Aqueous flare was significantly negatively correlated with SCT. Conclusion: Growth and inflammatory factors may be associated with SCT, and changes in SCT may be associated with changes in BCVA after IRI to treat macular edema due to CRVO.

Effect of Intravitreal Ranibizumab Injection on Different Optical Coherence Tomographic Patterns of Diabetic Macular Edema

Giriş ve Amaç: Spektral-domain optik koherens tomografi (SD-OKT) ile belirlenen farklı paternlerdeki diyabetik maküla ödemi (DMÖ) olgularında intravitreal ranibizumab (İVR) enjeksiyonunun erken dönem etkinliğini karşılaştırmak.
 Gereç ve Yöntemler: Tek doz İVR uygulanmış nonproliferatif diyabetik retinopatiye sekonder DMÖ olguları retrospektif olarak analiz edildi. Klinik anlamlı santral DMÖ’sü olan ve santral fovea kalınlığı (SFK)≥250 µm olan gözler çalışmaya dahil edildi. Olgular SD-OKT morfolojisine göre; süngerimsi diffüz retina kalınlaşması (DRK), kistoid maküla ödemi (KMÖ) ve seröz retina dekolmanı (SRD) gruplarına ayrıldı. Gruplar enjeksiyon öncesi ve enjeksiyon sonrası birinci ay kontrollerinde, en iyi düzeltilmiş görme keskinliği (EİDGK), SFK ve total maküla volümü (TMV) değişimi açısından karşılaştırıldı. SFK değişimi üzerindeki başlangıç SFK değerlerinin etkisini dışlamak için ANCOVA analizi ve gruplar arasında randomizasyon yapılarak alt analizler yapıldı. 
 Bulgular: Çalışmaya 101 olgu (44 DRK, 40 KMÖ ve 17 SRD) dahil edildi. Gruplar yaş ve cinsiyet dağılımı açısından benzerdi (p>0,05). Başlangıç EİDGK ve TMV değerleri arasında anlamlı fark yok iken (p>0,05), başlangıç SFK değerleri büyükten küçüğe doğru sırası ile SRD, KMÖ ve DRK şeklinde sıralandı (p

Intravitreal injection of ranibizumab for treatment of macular edema secondary to retinal vein occlusion

ObjectiveThis study aims to evaluate the effect of ranibizumab for treatment of macular edema (ME) secondary to retinal vein occlusion (RVO).Patients and methodsThis is a prospective case series study that included 35 eyes of patients with ME due to RVOs. This study was conducted in Menoufia University Hospital during the period study from March 2018 till February 2020. The study protocol was approved by the medical research ethics committee of Faculty of Medicine, Menoufia University.ResultsThere was a significant improvement in the best-corrected visual acuity (VA) value in the fourth month postoperatively than preoperatively, whereas there was no change in the sixth month postoperatively than preoperatively (P1 < 0.025, P2 < 0.17, and P3 < 0.025, respectively). There was a significantly improvement in the central macular thickness (CMT) at 4 and 6 months postoperatively than preoperatively (P1 < 0.001, P2 < 0.001, and P3 > 0.037, respectively). Moreover, there was a significant positive correlation between preoperative CMT and Snellen VA, CMT at fourth month postoperatively, and CMT at sixth month postoperatively (P < 0.05).ConclusionsCMT and best-corrected VA were significantly improvement at 4 and 6 months postoperatively compared with preoperatively. In the current study, during the follow-up, no patients showed any severe local adverse events such as retinal detachment, retinal tears, endophthalmitis, or uveitis, and none showed progression to ischemia or rubeosis iridis. No patients experienced any systemic adverse effects. Finally, evaluation of the short-term effect of intravitreal ranibizumab injection can be used to predict the outcome of the therapy at 1 week and 1 month after injection for the ME secondary to RVO.

Relationship between metamorphopsia and inner retinal microstructure following intravitreal ranibizumab injection for branch retinal vein occlusion

To evaluate the effects of intravitreal ranibizumab injection (IVR) on metamorphopsia in patients with branch retinal vein occlusion (BRVO), and to assess the relationship between metamorphopsia and inner retinal microstructure and other factors. Thirty-three treatment-naïve eyes of 33 patients with macular edema caused by BRVO with at least 12 months of follow-up were included. The degree of metamorphopsia was quantified using the M-CHARTS. Retinal microstructure was assessed with spectral-domain optical coherence tomography. Disorganization of the retinal inner layers (DRIL) at the first month after resolution of the macular edema (early DRIL) and at 12 months after treatment (after DRIL) was studied. Central retinal thickness (CRT), and status of the external limiting membrane as well as ellipsoid zone were also evaluated. IVR treatment significantly improved best-corrected visual acuity (BCVA) and CRT, but the mean metamorphopsia score did not improve even after 12 months. Post-treatment metamorphopsia scores showed a significant correlation with pre-treatment metamorphopsia scores (P < 0.005), the extent of early DRIL (P < 0.05) and after DRIL (P < 0.05), and the number of injections (P < 0.05). Multivariate analysis revealed that the post-treatment mean metamorphopsia score was significantly correlated with the pre-treatment mean metamorphopsia score (P < 0.05). IVR treatment significantly improved BCVA and CRT, but not metamorphopsia. Post-treatment metamorphopsia scores were significantly associated with pre-treatment metamorphopsia scores, the extent of DRIL, and the number of injections. Prognostic factor of metamorphopsia was the degree of pre-treatment metamorphopsia.

Can Vitreous Reflux Affect The Short-Term Treatment Response After Intravitreal Ranibizumab Injection?

ABSTRACT Purpose The aim of this study was to evaluate the effect of vitreous reflux (VR) on the short-term effect of intravitreal ranibizumab injection. Materials and Methods The study included 181 eyes of 81 age-related macular degeneration (AMD) and 100 diabetic macular edema (DME) patients. Treatment response was evaluated by measuring central macular thickness (CMT) as well as 1 mm and 3 mm central macular thicknesses (MT1 and MT3). Patients were grouped as; Group 1: no VR, Group 2: <3 mm VR, and Group 3: >3 mm VR according to conjunctival bleb diameters. The data were analyzed using variance, correlation and regression analyses. Results In AMD patients, reduction of CMT values following the treatment were 88.3 ± 110.6 µm in Group 1, 85.6 ± 158.7 µm in Group 2, and 93.1 ± 92.2 µm in Group 3. Likewise, in DME patients, it was 82.4 ± 88.4 µm, 72.9 ± 109.9 µm, and 73.7 ± 113.7 µm, respectively. Reduction of MT1 values after the treatment were 47.4 ± 72.6 µm, 36.0 ± 131.9 µm, and 36.7 ± 114.4 µm in AMD patients, and 33.3 ± 72.5 µm, 36.6 ± 90.2 µm, and 46.9 ± 83.4 µm in DME patients. In all comparisons among groups of VR, macular thickness (MT) change did not exhibit significant difference following an intravitreal ranibizumab treatment (p > .05). Conclusion We found that the increase in VR amount did not adversely affect the decrease in MT after intravitreal ranibizumab treatment in AMD and DME patients.

The Effect of Intravitreal Ranibizumab Injection on Systemic Blood Pressure: A Prospective Study

Introduction: Hypertension is a common disease, which may be induced or precipitated by antivascular endothelial growth factor therapy with many studies reporting this complication of this therapy. Methods: This is a prospective study to evaluate blood pressure changes in normotensive, controlled and uncontrolled hypertensive patients on regular medical treatment after a 0.05 ml (0.5 mg) intravitreal Ranibizumab injection. It was held in Ibn-alhaitham eye teaching hospital in Baghdad between May 2019 and December 2019. It included patients with variable retinal diseases receiving either unilateral or bilateral intravitreal Ranibizumab injections, their blood pressure was measured before the treatment as a baseline, and then 2 hours, 1 month, and at 3 months from the first injection(s). These were allocated to three groups; Group A included normotensive patients without history of hypertension; Group B included controlled hypertensives and those with grade 1 hypertension with antihypertensive treatment. Group C included those with Grade 2 hypertension or more with antihypertensive treatment. Blood pressure was measured in all patients using the manual sphygmomanometer in sitting position. Paired t-test was used to analyze blood pressure measurements and compare mean arterial, systolic and diastolic pressure. A P-value of ≤ 0.05 was considered significant, and a P-value of ≤ 0.001 was considered highly significant. Results: Seventy-five patients (n=75) were included in the study with a mean age of 59.1 ± 11.4 years 58.7% males and 41.3% females, 44% were controlled-hypertensives, 26.7% were uncontrolled-hypertensives, 29.3% were normotensives. Group C showed highly significant reduction in the mean arterial, and systolic pressures in all three measurements after baseline (P ≤ 0.001), and significant reduction of diastolic blood pressure at one and three months after baseline (P ≤ 0.05). Both groups A and B showed a reduction in most measurements, but most were statistically insignificant (P ≥ 0.05). Unilateral and bilateral injection groups showed similar reduction in the mean arterial pressure at 2 hours and 3 months (P ≤ 0.05), mean systolic blood pressure was reduced in unilateral group in all 3 measurements (P ≤ 0.05, P ≤ 0.05, P ≤ 0.001, respectively) and also in the bilateral group at 2 hours and 3 months (P ≤ 0.001, P ≤ 0.05 respectively), and mean diastolic blood pressure was reduced at 2 hours in the unilateral group (P ≤ 0.05), and at 3 months in the bilateral injection group (P ≤ 0.05). Conclusion: There is an overall reduction of blood pressure with Ranibizumab Intravitreal injections especially in the moderate to severely uncontrolled hypertensive patients, while controlled-hypertensive, mildly uncontrolled hypertensive showed statistically insignificant changes which indicates that, it is acceptable to continue using Ranibizumab in both normotensive and hypertensive patients in the short term.

Evaluation of The Effect of Combined Intra-Vitreal Ranibizumab Injection and Sub-Tenon Tri-Amcinolone Acetonide Injection in The Management of Diabetic Macular Edema

Background: to monitor and compare the effect of intravitreal ranibizumab injection alone or with sub-tenon triamcinolone acetonide injection on patients with diabetic macular edema. Aim of the Work: To assess the effect of combined intravitreal ranibizumab injection, and sub-tenon triamcinolone acetonide injection in the management of diabetic macular edema. Patients and Methods: Patients with non-proliferative diabetic retinopathy associated with DME (Central macular thickness over 300 um) which are aimlessly divided into two groups. In group 1, three monthly doses (0.5 mg) of intravitreal ranibizumab are received. In group 2, the anti-VEGF injection was performed 10 days after the sub-tenon steroid injection [triamcinolone acetonide]. All patients’ visual acuity, IOP and CMT were followed up for 3 months. Results: The combined treatment showed improved best corrected visual acuity from baseline 0.24 ± 0.32 log MAR to 0.56 ± 0.18 log MAR (p = 0.023) which was statistically significant. In addition, there was decreased CMT from baseline 420.1 ± 112.84 to 275.73 ± 90.81 which was highly statistically significant (p > 0.001). When comparing the combination treatment with the anti-VEGF treatment alone, recovery of BCVA and CMT was statistically significant (p = 0.041 and p = 0.001, respectively). Conclusion: Steroid addition to the routine anti-VEGF therapy is an effective method of treatment of diabetic macular edema

Evaluation of The Effect of Combined Intra-Vitreal Ranibizumab Injection and Sub-Tenon Tri-Amcinolone Acetonide Injection in The Management of Diabetic Macular Edema

Background: to monitor and compare the effect of intravitreal ranibizumab injection alone or with sub-tenon triamcinolone acetonide injection on patients with diabetic macular edema. Aim of the Work: To assess the effect of combined intravitreal ranibizumab injection, and sub-tenon triamcinolone acetonide injection in the management of diabetic macular edema. Patients and Methods: Patients with non-proliferative diabetic retinopathy associated with DME (Central macular thickness over 300 um) which are aimlessly divided into two groups. In group 1, three monthly doses (0.5 mg) of intravitreal ranibizumab are received. In group 2, the anti-VEGF injection was performed 10 days after the sub-tenon steroid injection [triamcinolone acetonide]. All patients’ visual acuity, IOP and CMT were followed up for 3 months. Results: The combined treatment showed improved best corrected visual acuity from baseline 0.24 ± 0.32 log MAR to 0.56 ± 0.18 log MAR (p = 0.023) which was statistically significant. In addition, there was decreased CMT from baseline 420.1 ± 112.84 to 275.73 ± 90.81 which was highly statistically significant (p > 0.001). When comparing the combination treatment with the anti-VEGF treatment alone, recovery of BCVA and CMT was statistically significant (p = 0.041 and p = 0.001, respectively). Conclusion: Steroid addition to the routine anti-VEGF therapy is an effective method of treatment of diabetic macular edema

The Influence of Intravitreal Ranibizumab on Inflammation-associated Cytokine Concentrations in Eyes With Diabetic Macular Edema.

To evaluate the effect of intravitreal ranibizumab injections on aqueous concentrations of angiogenic or inflammatory cytokines in patients with diabetic macular edema (DME). Thirty eyes of 25 patients with center-involved DME were recruited to the study. All had a central macular thickness (CMT) of >300 μm and best-corrected visual acuity (BCVA) between 28 and 70 logMAR letters (Snellen equivalent 20/320-20/40). At baseline, all eyes had 0.1 mL of aqueous collected before ranibizumab treatment. At week 4, a second ranibizumab injection was administered and at week 8, aqueous sampling was repeated before a third ranibizumab injection. From week 12, all eyes were followed at 4-weekly intervals and the need for ranibizumab treatment was determined by BCVA and CMT measurements. Levels of 32 cytokines were assessed at baseline and at week 8 using a multiplex array assay. Following two consecutive ranibizumab injections, there was a statistically significant reduction in VEGF (P < 0.00001), as well as IL-1β (P = 0.00006), IL-7 (P = 0.00002), IL-8 (P = 0.00023), IL-10 (P < 0.00001), IL-12 (P < 0.00001), IL-17 (P = 0.00024), MCP-1 (P = 0.00023), and TNF-α (P < 0.00001). There was also an upregulation of soluble VEGF receptor-2 (P = 0.00004). A P < 0.0015 was considered significant in this study. Ranibizumab treatment influences various inflammatory cytokine concentrations in addition to reducing aqueous VEGF concentrations in patients with DME. This may contribute to its therapeutic effect in patients with DME.

TIME COURSE OF CHANGES IN METAMORPHOPSIA FOLLOWING INTRAVITREAL RANIBIZUMAB INJECTION FOR BRANCH RETINAL VEIN OCCLUSION.

To evaluate the effects of intravitreal ranibizumab injection (IVR) on metamorphopsia in patients with branch retinal vein occlusion (BRVO) and to assess the relationship between retinal microstructure and metamorphopsia. Subjects were 39 eyes of 39 patients with branch retinal vein occlusion. The severity of metamorphopsia was quantified using the M-CHARTS before and 1, 2, 3, 4, 5, and 6 months after treatment. Based on optical coherence tomography (OCT) images, we assessed central retinal thickness (CRT) and status of the external limiting membrane (ELM) and ellipsoid zone (EZ). The association between retinal microstructure and metamorphopsia was analyzed in 24 eyes with treatment-naïve branch retinal vein occlusion. Intravitreal ranibizumab injection treatment significantly improved best-corrected visual acuity (BCVA) and central retinal thickness (P < 0.0001, P < 0.0001, respectively), but metamorphopsia did not improve by treatment. Posttreatment metamorphopsia scores showed a significant correlation with duration of symptoms (P < 0.05) and pretreatment metamorphopsia scores (P < 0.01). Posttreatment metamorphopsia score was significantly worse in patients with disruption of external limiting membrane (P < 0.05). In patients with branch retinal vein occlusion, intravitreal ranibizumab injection treatment significantly improved best-corrected visual acuity and central retinal thickness, but not metamorphopsia. The severity of posttreatment metamorphopsia was significantly associated with duration of symptoms, degree of pretreatment metamorphopsia, and posttreatment integrity of external limiting membrane.

Effect of anti-VEGF treatment on retinopathy of prematurity in Zone II Stage 3+

To evaluate the effect of intravitreal ranibizumab injection for retinopathy of prematurity (ROP) in Zone II Stage 3+. Data was collected for ROP patients with Zone II Stage 3+ who received intravitreal ranibizumab injections between October 2014 and Janu-ary 2017 at the Department of Ophthalmology in our hospital. No prior laser or other intravitreal treatment was done. Prior to the intervention and at each follow-up visit, fundus examination was performed. Gestational age at birth, sex, birth weight, ROP zone, ROP stage, post menstrual age (PMA) at treatment, and follow-up pe-riod were recorded. The final clinical status of the retina was evaluated for each patient. The primary outcome mea-sures included ROP recurrences requiring re-treatment, complete or incomplete peripheral vascularization. Eighty-six eyes of 46 premature infants with Zone II Stage 3+ ROP were enrolled in the study. The mean gestational age at birth was 28.18±1.67 (range: 25 to 33)wk and the mean birth weight was 1070.57±226.85 (range: 720.00 to 1650.00) g. The mean PMA at treatment was 38.32±2.99 (range: 32.29 to 46.00)wk. Seventy-one eyes (82.56%) were treated success-fully with intravitreal ranibizumab as monotherapy. Fifteen eyes (17.44%) developed recurrent disease. The mean interval between the treatment and retreatment was 5.96±3.22 (range: 1.86 to 11.71)wk. All eyes vascularized into zone III at the end of the study and among them 62 eyes (72.09%) achieved complete vascu-larization. Intravitreal ranibizumab injection is an effective treatment in Zone II Stage 3+ ROP patients. More patients with longer follow-up duration are necessary to confirm the safety and efficacy of this treatment.

Intravitreal injection of Ranibizumab for the treatment of macular edema due to branch retinal vein occlusion

Objective To observe the clinical effects of intravitreal Ranibizumab injection (IVR) for the treatment of the macular edema due to branch retinal vein occlusion. Methods Sixty seven consecutive cases eyes of 67 of the macular edema due to branch retinal vein occlusion treated by IVR (10 mg/ml, 0.05 ml) were retrospectively analyzed. All the cases were divided by the following two methods. According to the time between oncome of the macular edema and the first therapy, the patients were divided into 3 groups: group 1 of less than 1 week, group 2 of 1week-3 months and group 3 of over 3 months. And according to the treating regulation, the patients were divided into 2 groups: treatment on time group and treatment on demand group. The follow-up contents included the best corrected visual acuity (BCVA, LogMAR), 1 mm diameter macular central retinal thickness (CRT) and fluorescence fundus angiography (FFA). The average follow-up period was (13.2±1.3) months. Results When the group division according to the time between oncome of the macular edema and the first therapy, the BCVA of the patients in group 1 was 0.131±0.061 and CRT was (268±21) μm two months after the treatment. The BCVA was 0.086±0.042 and CRT was (259±19)μm 12 months after the treatment. In group 2, the BCVA was 0.276±0.112 and CRT was (321±45) μm 2 months after the treatment and the BCVA was 0.292±0.105 and CRT was (268 ±29) μm 12 months after the treatment. In group 3, the BCVA was 0.523±0.164 and CRT was (441±67) μm two months after treatment, and the BCVA was 0.387±0.142 and CRT was (281±24) μm 12 months after the treatment. When compared with the group 1, at every follow-up time point, the differences in the BCVAs were statistically significant between group 1 and group 2 (all P<0.01). The CRTs at 2, 4, 6 months after the treatment between group 1 and group 3 had statistically significant differences (all P<0.01). When the group division according to the treatment regulation, 12 months after the treatment, the BCVA was 0.208±0.091 in the treatment on time group and was 0.387±0.184 in the treatment on demand group and the difference was statistically significant (t=4.35, P<0.01). Twelve months after the treatment, the CRT was (290±46) μm in the treatment on time group and was (311±51) μm in the treatment on demand group, and the difference was not statistically significant(t=0.98, P=0.56). Conclusion The curative effect of IVR for retinal edema due to branch retinal vein occlusion is obvious. Early and on time treatment could significantly improve the effects. Key words: Branch retinal vein occlusion; Edema, macular; Ranibizumab, intravitreal injection; Visual acuity

Effects of Intravitreal Ranibizumab Injection on Chinese Patients with Wet Age-Related Macular Degeneration: 5-Year Follow-Up Results.

Purpose. To observe the effect of intravitreal ranibizumab injection on wet age-related macular degeneration (wAMD) over 5 years in Chinese patients. Methods. Thirty-seven patients who were diagnosed with wAMD in our hospital from June 2007 to June 2014 were retrospectively reviewed. The PRN regimen and the treatment and extend regimen were applied. Best corrected visual acuity (BCVA), number of ranibizumab injections, and changes in the choroidal neovascularization (CNV) lesion over 5 years were analyzed. Results. The mean BCVA measured by the ETDRS chart at baseline was 47.4 and 5 years after the treatment it was 34.89 letters, which was significantly different (p = 0.013). Fourteen eyes (37.8%) had improved visual acuity after 5 years. The number of injections in 5 years was 11.53, and most of the injections were in the first two years. Seventeen (45.9%) cases developed fibrous lesions, and 2 (5.4%) cases had atrophic lesions after 5 years. The fibrosis/atrophy was significantly correlated with the injection numbers (Pearson, r = 0.663, and p = 0.000). Conclusion. Most of the patients can maintain visual acuity treated by ranibizumab in the first 3 years. After 5 years, some patients can still improve or maintain visual acuity. Fibrous scarring of the lesion is the main reason for a decrease in vision of wAMD patients.

Foveal Damage Due to Subfoveal Hemorrhage Associated with Branch Retinal Vein Occlusion.

To investigate the functional and morphologic prognoses of eyes with subfoveal hemorrhage from acute branch retinal vein occlusion (BRVO), and to examine the effect of intravitreal ranibizumab injection (IVR) on these prognoses, we assessed 81 eyes with acute BRVO, of which 38 did not receive IVR [IVR(-) group], and 43 were treated with IVR [IVR(+) group] for macular edema. The foveal morphologic changes were examined via optical coherence tomography (OCT). At initial examination, 63 eyes exhibited subfoveal hemorrhage. At final examination, the defect lengths in the foveal external limiting membrane (ELM) and ellipsoid lines in these eyes were longer, and final VA was significantly poorer, compared with eyes without subfoveal hemorrhage. In comparisons between the final measurements in eyes with subfoveal hemorrhage in the IVR(-) and IVR(+) groups, while there were no differences in initial ocular conditions, final VA was significantly better in the IVR(+) group. The defects in the ELM and ellipsoid lines in the IVR(+) group were shorter than those of the IVR(-) group (p = 0.002 in both). Final VA was correlated with the defect lengths of foveal ELM and ellipsoid lines in both the IVR(-) and IVR(+) groups (both p < 0.001). In addition, the defect lengths of foveal ELM and ellipsoid lines were closely correlated with the duration of subfoveal hemorrhage (both p < 0.001). BRVO-associated subfoveal hemorrhage caused damage to the foveal photoreceptors, and visual dysfunction. However, IVR improved these prognoses, by accelerating the absorption of the subfoveal hemorrhage.

Evaluation of the effect of intravitreal ranibizumab injections in patients with neovascular age related macular degeneration on retinal nerve fiber layer thickness using optical coherence tomography.

PurposeTo evaluate the effect of repeated intravitreal ranibizumab injections for neovascular age related macular degeneration (nAMD) on the retinal nerve fiber layer (RNFL) thickness using optical coherence tomography.DesignA prospective observational cohort study of patients with nAMD.MethodsThirty eyes of 30 patients with nAMD were selected. All patients received three ranibizumab injections and underwent scans using the fast RNFL thickness protocol (Stratus optical coherence tomography) before starting the first injection and 1 month after the third injection. The RNFL thickness measurements prior to the injections and after the third injection were used for the analysis. We also evaluated the effect of the lens status as well as the type of choroidal neovascular membrane on RNFL thickness measurements pre- and post-injection. Pre- and post-injection average and individual quadrant RNFL thickness were measured and statistically analyzed.ResultsThe mean (± standard deviation) pre-injection RNFL thickness was 90.8±18. The mean (± standard deviation) post-injection RNFL thickness was 91.03±15. The pre- and post-injection values of the mean RNFL thickness were not statistically significant. Likewise, the pre- and post-injection values for RNFL thickness in the different quadrants were not statistically significant. There was no statistical significance for the lens status or the type of choroidal neovascular membrane on the RNFL thickness.ConclusionRepeated ranibizumab injections in nAMD appear to have no harmful effect on the RNFL thickness in the short term, in spite of the proven neurotrophic effect of vascular endothelial growth factor. Nevertheless, the safety profile of ranibizumab injections in nAMD needs to be further evaluated in a large multicenter trial with special emphasis on the long-term effects on the retina and optic nerve.

Effect of intravitreal ranibizumab injections on aqueous humour concentrations of vascular endothelial growth factor and pigment epithelium-derived factor in patients with myopic choroidal neovascularisation

AimsTo investigate aqueous humour changes in vascular endothelial growth factor (VEGF) and pigment epithelium-derived factor (PEDF) levels in patients with choroidal neovascularisation (CNV) secondary to pathological myopia (mCNV) before and...

Intravitreal Ranibizumab for Diabetic Macular Edema Treatment in Phakic Vitrectomized Eyes

Purpose: To show the effect of intravitreal ranibizumab injections in treating DME in phakic vitrectomized eyes versus pseudophakic vitrectomized eyes. Method: The medical records of 12 patients seen in the Retina Clinic and diagnosed to have DME were prospectively reviewed. The inclusion criteria were Phakic vitrectomized eyes. The exclusion criteria were pseudophkia and vitrectomized eyes with internal limiting membrane peeling. The main outcome measures included mean change in best corrected visual acuity (BCVA) from baseline, mean change in CMT, and mean number of 0.5 mg intravitreal ranibizumab injections administered during the follow up. Result: At baseline assessment, the mean (±SD) Logarithm of the Minimum Angle of Resolution (Log MAR visual acuity) was 0.71 (±0.56). At the 12 weeks, follow up assessment the mean Log MAR VA was significantly improved to 0.32 (±0.20), (p = 0.036). At baseline assessment, OCT was 390.75 (±51.40). The mean OCT at 4 weeks was significantly reduced to 353.83 (±49.49), (p = 0.019). Furthermore, at the 8 weeks follow up assessment, the mean OCT continued its significant trend of improvement to reach 341.08 (±60.24), (p = 0.016) and 294.42 (±57.27) in the 8 and 12 weeks follow up assessments respectively. Conclusion: In this small, prospective series, there was improvement in BCVA and CMT in the short-term after intravitreal Ranibizumab (IVR) for DME in previously phakic vitrectomized eyes. This may be attributable to a more remaining peripheral vitreous in phakic eyes behind the crystalline lens after vitrectomy which may clog the zonular area between anterior and posterior chambers and slowing down the antiVEGF clearance through the anterior chamber. Thus, vitreous works as a reservoir for anti-VEGF in phakic vitrectomized eyes comparing to pseudophakic vitrectomized eyes.

INTRAVITREAL RANIBIZUMAB FOR CHOROIDAL NEOVASCULARIZATION WITH LARGE SUBMACULAR HEMORRHAGE IN AGE-RELATED MACULAR DEGENERATION

To evaluate the effects of intravitreal ranibizumab injections in the treatment of choroidal neovascularization with large submacular hemorrhage secondary to age-related macular degeneration. Prospective interventional case series. Patients presenting occult choroidal neovascularization with flat large submacular hemorrhage >50% of the entire lesion were considered. The protocol required 3 monthly consecutive injections, followed by repeat injections over the 12-month follow-up on the basis of optical coherence tomography parameters and angiographic features. Twenty-three patients were enrolled in the study and prospectively followed up. Mean best-corrected visual acuity and mean central macular thickness at the baseline were 0.82 ± 0.22 (logarithm of the minimum angle of resolution ± standard deviation) and 342 ± 56 µm, respectively. At 12-month examination, mean visual acuity improved significantly to 0.68 ± 0.41 (P = 0.04), and mean central macular thickness decreased to 236 ± 26 µm (P < 0.0001). A progressive resolution of macular bleeding was registered in 22 of 23 patients. No side effect or complication was registered. Intravitreal ranibizumab can be considered a beneficial approach for the management of choroidal neovascularization with flat large submacular hemorrhage secondary to age-related macular degeneration.

Ganglion Cell Complex Evaluation in Exudative Age-Related Macular Degeneration after Repeated Intravitreal Injections of Ranibizumab

Purpose. To detect the effects of intravitreal ranibizumab injections on GCC in patients with wet AMD.Methods. 32 wet AMD eyes were selected and submitted at three ranibizumab injections. RTVue-OCT GCC and MM5 protocol were performed before treatment and twenty days after each injection.Results. At baseline mean GCC thickness was 93.9 ± 18.5 μm. Twenty days after each intravitreal injection it was, respectively, 85.8 ± 10.1, 86.5 ± 9.3, and 91.1 ± 11.5 μm, without statistical significance. A significant improvement in visual acuity (P= 0.031) and a reduction of mean foveal (P= 0.001) and macular thickness (P= 0.001) were observed.Conclusion. The clinical results confirm therapeutic efficacy of intravitreal injections of ranibizumab in wet AMD. A contemporary not statistically significant reduction of GCC thickness suggests that the loading phase of ranibizumab does not have any toxic effects on ganglion cell complex.