Alterations of vascular pigment epithelium detachments associated with age-related macular degeneration during upload with intravitreal ranibizumab

Armin Wolf, Johann Rüping, Aljoscha S Neubauer, Wolfgang Mayer, Michael Ulbig, Christos Haritoglou, Frank G Holz, Nicole Eter, Anselm Kampik
Retina 2013, 33 (9): 1843-9

PURPOSE: To describe morphologic alterations of pigment epithelial detachments (PEDs) associated with neovascular age-related macular degeneration during anti-vascular endothelial growth factor upload therapy with ranibizumab.

METHODS: Prospective, single-arm interventional study. Primary outcome was the reduction of height of PED during monthly treatment using ranibizumab. Secondary outcomes were factors influencing the regression of PED. Inclusion criteria were presence of PED associated with naive neovascular age-related macular degeneration, visual acuity of >20/200, and height of PED >150 μm on optical coherence tomography. All eyes (n = 54) received 3 injections of ranibizumab in monthly intervals ("upload therapy"). Last review examination was performed 14 weeks after the initial treatment.

RESULTS: The mean PED height decreased from 515 μm (SD, 268.3) to 294 μm (SD, 201.9) at Week 14 with the highest degree of regression after the first treatment. A complete resolution of PED was noted in 8 eyes (15%). Using conventional regression model, none of the factors investigated, including height of PED, presence of intraretinal or subretinal fluid, intraretinal cysts, macular volume, retinal thickness, presence of foveal depression, presence of hemorrhage, and visual acuity, had a significant impact on the morphologic response. Using a modified binary logistic regression model ("bootstrapping"), presence of foveal depression (P > 0.033), and retinal thickness (P > 0.004) showed statistical significance.

CONCLUSION: This study on the responses and potential predictive factors associated with vascularized PED during the uploading phase of intravitreal ranibizumab shows a complete resolution of the PED in 15% of the cases.

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