Journal List > J Korean Ophthalmol Soc > v.52(7) > 1009083

Cho and Park: Intravitreal Ranibizumab Therapy for Neovascular Age-Related Macular Degeneration with a Predominantly Hemorrhagic Lesion

Abstract

Purpose

To report the efficacy and safety of intravitreal ranibizumab monotherapy in patients with age-related macular degeneration with a predominantly hemorrhagic lesion.

Methods

Nineteen eyes of 19 patients with submacular hemorrhage involving the fovea were treated with intravitreal ranibizumab (0.5 mg/0.05 ml) injections as needed. All patients completed at least 4 months of follow-up. Ophthalmologic examinations, fluorescence angiographic evaluations, optical coherence tomography (OCT) examination, and hemorrhage size were analyzed before the injections, and at 1,2,4,6, and 12 months follow-up.

Results

The average VA and mean central retinal thickness (CRT) before ranibizumab treatment were 0.62 ± 0.39 log MAR and 335.76 ± 111.22 μ m, respectively. Additionally, the VA and CRT four months after the initial injections were 0.54± 0.43 log MAR and 241.42 ± 107.55 μ m, respectively. The mean size of the hemorrhage was significantly reduced from 2.87 ± 2.44 DA (disk areas) at baseline to 0.9 ± 1.28 DA at four month follow up.

Conclusions

Intravitreal injection of ranibizumab is an effective treatment option for patients with age-related macular degeneration with a predominantly hemorrhagic lesion.

References

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Figure 1.
Changes in best corrected visual acuity (BCVA) after intravitreal ranibizumab injection. Best corrected visual acuity improved at 1 month from baseline, a difference that was statistically significant (p < 0.001), this level of BCVA was maintained throughout 2 months. * Not significant differences.
jkos-52-838f1.tif
Figure 2.
Changes in central macular thickness with OCT during follow-up after intravitreal ranibizumab injection. The foveal thickness improved after 1 month, the mean central macular thickness measurements decreased from 335.74 ± 111.22 μ m to 271.42 ± 76.9 μ m (p = 0.006) and this overall improvement continued throughout 4 month follow-up.
jkos-52-838f2.tif
Figure 3.
Correlation analysis between the decrease of central macular thickness and the improvement of best-corrected visual acuity (BCVA) four months after initial treatment (Pearson correlation, r = 0.45; p= 0.055).
jkos-52-838f3.tif
Figure 4.
The fundus photographs (A, D), fluorescein angiographs (B, C) of patient 18. (A) Baseline fundus photograph showed submacular hemorrhage. (B, C) Early and late phase fluorescein angiography at baseline. Blocked fluorescence is seen around the hyperfluorescence. (D) Fundus photograph at 4 months after treatment showed resolution of hemorrhage.
jkos-52-838f4.tif
Table 1.
Characteristics of study subjects
Characteristics Value
Number of eyes (patients) 19 (19)
Age (mean ± SD*, yr) 67.63 ± 11.45
Sex (M:F) 13:6
Symptom duration (mean ± SD, day) 37.58 ± 33.67
Number of injection (mean ± SD) 3.53 ± 0.7
Baseline mean BCVA (mean ± SD, log MAR) 0.62 ± 0.39
Baseline mean central foveal thickness (mean ± SD, μ m) 335.74 ± 111.22
Baseline mean lesion area (mean ± SD, DA) 4.12 ± 3.18
Baseline mean hemorrhage area (mean ± SD, DA) 2.87 ± 2.44
Mean time for the hemorrhage clear (mon [range]) 4.1 (3–8)

* SD = standard deviation

log MAR = logarithm of the minimum angle of resolution

DA = disk areas.

Table 2.
Patients' characteristics at Baseline, 1, 2 and 4 months
Pt No Age (yr) Sex Follow-up months BCVA* (log MAR) Baseline Lesion area (DA§) Total area of hemorrhage (DA) CMT (μ m)
Baseline Month 1 Month 2 Month 4 Baseline Month 1 Month 2 Month 4
1 76 F 13 1.3 1.3 0.8 0.9 10.4 8.6 450 271 221 312
2 54 M 12 0.4 0.4 0.3 1.1 6.6 5.9 318 360 230 266
3 67 M 12 0.3 0.2 0.2 0.3 1.3 0.7 287 328 291 245
4 76 M 14 0.3 0.3 0.2 0.3 1.4 1.2 288 205 189 170
5 67 F 6 0.3 0.2 0.1 0.2 1.5 0.8 251 317 267 231
6 52 M 4 0.4 0.3 0.2 0.3 1.5 0.8 282 189 186 210
7 90 F 4 0.3 0.2 0.3 0.3 3.4 2.6 225 226 169 154
8 60 M 6 0.6 0.4 0.3 0.9 3.0 2.1 333 278 162 210
9 57 M 12 0.5 0.5 0.2 0.1 2.5 1.9 388 227 170 184
10 73 F 4 0.4 0.3 0.2 0.2 2.6 2.0 401 213 204 165
11 57 F 4 0.5 0.4 0.2 0.2 2.2 1.5 326 324 269 185
12 66 M 12 0.4 0.4 0.2 0.2 5.7 2.1 271 280 247 173
13 57 M 13 0.3 0.2 0.1 0.2 2.0 0.9 186 185 166 159
14 91 M 16 1.4 1.4 1.4 1.4 1.3 0.8 214 208 215 174
15 75 M 12 0.5 0.4 0.2 0.2 5.1 4.0 460 214 227 316
16 50 M 12 1.1 0.9 0.9 1.1 11.0 8.4 670 507 439 620
17 71 M 6 0.5 0.4 0.3 0.5 9.8 4.3 407 294 298 332
18 53 M 4 0.8 0.8 0.5 0.6 4.2 4.0 299 244 230 225
19 73 F 6 1.4 1.3 1.3 1.3 2.8 1.9 323 287 250 230

* BCVA = best corrected visual acuity

log MAR = logarithm of the minimum angle of resolution

CMT = central macular thickness

§ DA = disk areas.

Table 3.
BCVA analysis by subgroups
  4th month (n = 19) 6th month (n = 14) 12th month (n = 10)
No. eyes % No. eyes % No. eyes %
Decreased two or more log MAR lines of BCVA* 7 37 5 36 4 40
Remained stable 10 53 7 50 5 50
Improved two or more log MAR lines of BCVA 2 10 2 14 1 10

* BCVA = best corrected visual acuity

log MAR = logarithm of the minimum angle of resolution.

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