ABSTRACT.Purpose: To determine the efficacy of intravitreal injections of ranibizumab in the treatment of retinal angiomatous proliferation (RAP) in neovascular agerelated macular degeneration. Methods: Retrospective, consecutive case series of 26 eyes (26 patients) treated with intravitreal injections of 0.5 mg ranibizumab for RAP. Patients received intravitreal injections at monthly intervals during upload phase for a 3-month period. Results: Mean visual acuity before treatment was 0.75 ± 0.38logMAR (mean ± SD, n = 26). In the upload phase, mean visual acuity improved 4 weeks after the initial injection to 0.6 ± 0.37logMAR (n = 26) and to 0.53 ± 0.34logMAR (n = 26) 4 weeks after the third monthly intravitreal injection of ranibizumab. The mean optical coherence tomography (OCT) central foveal thickness reduced from 345 ± 55 lm at baseline to 215 ± 87 lm at 3 months. In the maintenance phase, mean visual acuity after 6 months was 0.66 ± 0.38logMAR (n = 12) and 0.7 ± 0.37logMAR after 9 months (n = 6). The mean OCT central foveal thickness was 259 ± 59 lm (n = 13) at 6 months and 280 ± 127 lm (n = 6) at nine-month follow-up. Conclusion: Intravitreal ranibizumab resulted in an improvement of visual acuity 4 weeks after the first injection but was more pronounced after 3 months. A reduction in leakage and OCT central foveal thickness was seen 3 months after the commencement of treatment.
Age-related macula degeneration (AMD) is the cause for one third of all pseudomelanomas. Because of its increasing incidence in the future, more attention must be paid to AMD in the differential diagnosis of chorioretinal lesions suspicious of melanoma.
Our 12-month results of TTT complementary to ruthenium brachytherapy with an attenuated tumour apex dose of 100 Gy for posterior choroidal melanoma with thickness = 4.5 mm are comparable to findings after TTT alone, especially in regard to regression course, low rate of sideeffects and visual results. ICG angiography might be a useful tool to monitor an eventual tumour regrowth in the choriocapillary layer. For evaluation of sideeffects of brachytherapy a postradiation follow-up of at least 2 - 5 years is mandatory.
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