Intravitreal Ranibizumab for Predominantly Hemorrhagic Choroidal Neovascularization in Age-Related Macular Degeneration

Abstract

Purpose: To evaluate the effects of intravitreal ranibizumab monotherapy on predominantly hemorrhagic choroidal neovascularization with foveal involvement associated with age-related macular degeneration. Materials and Methods: Twenty-two consecutive eyes with hemorrhagic neovascularization were treated with 3 monthly intravitreal ranibizumab injections. Additional injections were administered according to retreatment criteria during 12 months of follow-up. Results: A mean of 6.64 ± 1.36 injections was administered. Overall, the mean visual acuity increased from 10.90 ± 6.02 to 12.81 ± 8.34 ETDRS letters (p > 0.05) at 12 months. The ‘early treatment group' gained a mean of 2.83 ± 2.24 ETDRS letters (p < 0.05), while the ‘late treatment group' gained a mean of 0.30 ± 1.25 ETDRS letters (p > 0.05) with significant differences between the groups (p < 0.05). A progressive resolution of macular bleeding was registered in 20 patients (mean time: 5.3 ± 1.6 months). Conclusions: Ranibizumab injections can be considered a beneficial approach for the management of predominantly hemorrhagic choroidal neovascularization with foveal involvement associated with age-related macular degeneration. Furthermore, the time interval between hemorrhage and the first injection seems to be an important predicting factor of final visual acuity.

The use of microperimetry in assessing visual function in age-related macular degeneration

“…The majority of studies used the summary statistic MS, which is not age-corrected, and many of the studies did not report either the number or the spatial location of the stimuli upon which the MS was based 4,6,16,22,32,33,39,41,45,52 . Only 12 of the studies analysed the DLS at each given stimulus location 28,38,53,57,[60][61][62][63]65,[72][73][74] .…”

“…Microperimetry was undertaken by the Nidek MP1 or MP1-S in 29 of the 52 included articles 3,5,9,12,16,17,23,25,[32][33][34][35]39,41,43,45,48,49,51,52,[55][56][57][59][60][61][62][63]68 by the Nidek MP3 in 1 27 , by the MAIA in 13 4,6,11,65,[69][70][71][72][73][74][75][76][77] , by the Optos Spectral OCT/SLO in 7 13,20,[28][29][30]38,53 and by the Rodenstock SLO microperimeter in two articles 18,…”

“…Although all trials of anti-VEGF therapy involving microperimetry report an improvement in DLS from baseline, the results of these studies are equivocal with respect to the duration of therapy beyond which the DLS ceases to improve. A number of studies have found that DLS continues to improve up until 12 months, the time at which the studies ended 13,25,39,43,60 ;however, two studies suggest that DLS does not improve beyond that recorded after one week of treatment 9,35 . DLS can also decline following withdrawal of anti-VEGF therapy.…”