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Purpose: To analyze long-term changes in individual retinal layers (RLs) after intravitreal injections of ranibizumab (IVRs) in patients with neovascular age-related macular degeneration (n-AMD)., Methods: The patients were treated with 0.5-mg IVRs based on an as-needed protocol after the first three monthly doses over a 12-month follow-up period. Patients underwent optical coherence tomography and best-corrected visual acuity (BCVA) evaluation at each visit. The ETDRS grid with central subfield (R1) (r 0.5 mm) and the inner ring (R2) (r 0.5-1.5 mm) was used for calculation of the mean thickness of each RL. Changes in the thickness of segmented RLs within the R1 and R2 of ETDRS circles at months-3, -6, and -12 were compared to baseline., Results: The mean age was 72 ± 7.4 years. The mean number of injections was 9.08 (range 6-11). Mean BCVA improved from 49.7 ± 22.1 to 60.1 ± 19.8 letters. Central macular thickness decreased from 390.25 ± 149.6 to 312.74 ± 118.4 μm. Thicknesses of GCL (from 23.93 ± 13.73 to 19.50 ± 9.50 μm in R1; p 0.001, and from 44.5 ± 12.6 to 39.6 ± 10.6 μm in R2; p 0.005), IPL (from 28.90 ± 14.36 to 22.35 ± 6.23 μm in R1; p 0.001, and from 39.34 ± 8.53 to 35.58 ± 7.93 μm in R2; p 0.004), and total inner RL (ILM to ELM) (from 222.93 ± 93.09 to 180 ± 53 μm in R1; p 0.001, and from 255.06 ± 42.74 to 240.25 ± 40.37 μm in R2; p 0.003) in the central and parafoveal rings decreased statistically at month-12. Decrease in INL was limited to month-6 (from 34.80 ± 15.33 to 27.60 ± 12.59 μm in R1; p 0.001), while decreases in total outer RLs (ELM to RPE) (from 128.32 ± 26.92 to 115.54 ± 43.98 μm in R1; p 0.001, and 103.81 ± 16.73 to 96.38 ± 16.22 μm in R2; p 0.014) and RPE (from 39.12 ± 22.33 to 29.70 ± 22.05 μm in R1; p 0.001, and from 31.27 ± 13.11 to 24.40 ± 9.99 μm in R2; p 0.001) were limited to month-3., Conclusions: Significant changes were observed in the thickness of the inner RLs after 1-year treatment with IVRs for n-AMD. A significant decrease in RPE thickness confined to the first months disappeared at month-12.

Purpose : To study (i) the long-term effects of intravitreal ranibizumab treatment on changes in submacular choroidal thickness and (ii) the relationship between any resulting changes in choroidal thickness and visual outcomes following such treatment in patients with neovascular age-related macular degeneration (n-AMD). Methods : Reviewed were medical records of 30 consecutive, treatment-naïve, patients with unilateral n-AMD (n = 30 eyes) and unaffected fellow eyes (n = 26 eyes) (controls). Monthly injections of 0.5 mg ranibizumab were administered until stabilization of n-AMD, with additional injections as needed over the following 14-mo. Choroidal thickness was determined using enhanced-depth imaging-optical coherence tomography (EDI-OCT) before and after initiation of ranibizumab therapy. Choroidal thickness measurements were generated via manual segmentation. Results : The mean age of patients was 71.9 ± 7.4 (56-83) years; the mean best-corrected visual acuity (BCVA) of affected eyes improved from 51.1 to 59.4 letters ( p < 0.001); and the mean number of injections was 9.16 ± 1.75. Subfoveal choroidal thickness decreased from 208.3 ± 73.7 μm at baseline to 185.3 ± 70.1 μm at mo-14 ( p < 0.001), with significant ( p < 0.001) decreases at all measured time points. Choroidal thickness also tended to decline in fellow eyes but was only statistically significant nasally 1,000 μm ( p = 0.04). Mean changes in choroidal thickness did not correlate with BCVA at mo-14 ( p = 0.76). Disciform scars and geographic atrophy ( p = 0.017), and BCVA ( p < 001) at baseline were predictive of visual outcome. Age ( p = 0.001), reticular drusen ( p = 0.004), and size of choroidal neovascularized area ( p = 0.042) were predictive of decreases in choroidal thickness. Conclusions : Submacular choroidal thickness appeared to decrease significantly in eyes with n-AMD over a 14-mo period of ranibizumab treatment. No corresponding decrease in choroidal thickness occurred in fellow eyes.

Objective. To evaluate the correlation between visual outcomes and fluid configuration observed on spectral-domain optical coherence tomography (SD-OCT) in patients with wet age-related macular degeneration (AMD). Methods. Sixty-five eyes of 53 patients with AMD who were administered intravitreal ranibizumab treatment with 12 months of follow-up were included in this retrospective study. Presence of intraretinal cystoid fluid (IRC) and pigment epithelial detachment (PED), thickness of subretinal fluid (SRF), central macular thickness (CMT), and central macular volume (CMV) were assessed. Results. Subretinal fluid was observed in 29 eyes (45%), IRC in 36 eyes (55%), and PED in 39 eyes (60%). Baseline and final best-corrected visual acuity (BCVA) were 0.69±0.4 and 0.60±0.4 logMAR in the IRC negative group and 1.17±0.5 and 0.97±0.5 logMAR in the IRC positive group. BCVA was lower in IRC positive group (baseline p=0.001 and final=0.003); however, marked improvement was detected in both groups. Anatomic improvement and increased visual acuity were observed in groups with and without PED, IRC, and SRF. An inverse correlation was detected between pre-treatment CMT, IRC and post-treatment IRC, and final BCVA. Conclusion. Significant visual and anatomic improvement was observed after one-year of ranibizumab treatment regardless of fluid configuration. However, the presence of IRC was observed to be associated with worse visual acuity. Baseline retinal fluid configuration may have prognostic effects on functional success in patients treated with ranibizumab for wet AMD. Abbreviations. AMD = Age-related macular degeneration, VEGF = Vascular endothelial growth factor, IRC = intraretinal cystoid fluid, PED = pigment epithelial detachment, SRF = subretinal fluid, SD-OCT = spectral-domain ocular coherence tomography, IVR = intravitreal ranibizumab, BCVA = best-corrected visual acuity, FFA = fundus fluorescein angiography, CMT = central macular thickness, CMV = central macular volume., (©Romanian Society of Ophthalmology.)

Purpose: To evaluate long-term results and prognostic factors influencing long-term anatomical and functional outcomes in patients with diabetic macular edema (DME) undergoing intravitreal ranibizumab injection (IVRI). Methods: One-hundred-thirty eyes of 96 patients were evaluated retrospectively. Fundus fluorescein angiography(FFA) was performed during the baseline and as needed at the visits. Three consecutive monthly injection and then additional injections as needed were performed. Best-corrected visual acuity (BCVA) and optical coherence tomography (OCT) data at baseline, month 3, 6 and 12 were analyzed. Results: The mean age of the patients (50M-46F) was 62.06±7.63-years. Mean number of injection was 6.5±2.1. Baseline FFA showed diffuse edema in 56 eyes(43.1%), focal edema in 74 eyes(56,9%); and OCT showed cystic DME in 42 eyes(32,3%), swelling( sponge-like) and cystic DME in 43 eyes (33.1%), swelling-serous DME in 11 eyes(8.5%), cystic-serous in 27 eyes(20.8%), and serous in 7 eyes(5.4%). Peripheral retinal ischemia was present in 59 eyes(45.3%). Central macular thickness (CMT) at baseline, month 3, 6 and 12 was 433.7±149.6μm, 362.1±117.6μm, 342.4±101.6μm and 323.4±96.7μm, respectively (p<0,001). The mean LogMAR BCVA at baseline, month 3, 6 and 12 was 0.65±0.31, 0.47±0.28, 0.47±0.29 and 0.46±0.28, respectively (p<0,001). A statistically significant correlation was found between final BCVA and type of leakage, edema pattern, presence of peripheral retinal ischemia, baseline and final CMT and baseline BCVA Conclusion: The amount and type of leakage, BCVA and the presence of peripheral retinal ischemia at baseline as well as metabolic control seem to be significant prognostic factors influencing final visual outcome after long-term IVRI in patients with DME. [ABSTRACT FROM AUTHOR]

Objectives: To determine factors influencing compliance in patients with neovascular age-related macular degeneration (n-AMD) undergoing intravitreal anti-vascular endothelial growth factor (VEGF) therapy. Materials and Methods: The files of n-AMD patients recommended treatment with ranibizumab were reviewed retrospectively. The treatment regimen was 3 consecutive monthly injections followed by monthly follow-up with intravitreal injections as needed (pro re nata, PRN). Demographic and ocular characteristics were recorded. The patients were categorized into 2 groups: full compliance to treatment, or incomplete loading schedule and/or irregular maintenance treatment. All patients were interviewed by phone about factors affecting continuation of treatment. Results: Mean age of the 314 patients (160 female, 154 male) included in the study was 71.6±91 years. A total of 246 patients (78.3%) could complete 3 consecutive injections at 1-month intervals after the start of treatment; 57 patients (18.2%) did not attend monthly follow-up during the 1-year follow-up period following the 3 consecutive monthly injections. Overall, 39.8% of the patients were not able to fully comply with the ranibizumab treatment by PRN regimen for 1 year. Better visual acuity at baseline, smaller lesion size, living closer to the hospital, higher education and sociocultural level, and better financial status were determined as factors affecting patient compliance. The most frequent reasons to discontinue treatment were fear of injection, disbelief in the benefit of the treatment, financial limitations, continuation of treatment at another center, and comorbid systemic diseases. Conclusion: Patient compliance and success rates of anti-VEGF therapy may be increased by determining the factors affecting patient compliance and raising awareness about n-AMD among patients and their relatives. [ABSTRACT FROM AUTHOR]

Enhanced depth imaging spectral-domain optical coherence tomography (EDI-SD OCT) has made it possible to visualize and measure quantitively the choroid. In some studies, automated segmentation of choroid-sclera interface was used, but we think that many scans would necessitate manual correction of the automated segmentation because the choroid-sclera interface has not regular contour in most eyes. Our study was longitudinal, and we investigated changes in CT at different time points in a small group of wet age-related macular degeneration (AMD) treated with ranibizumab over 14 months of strict follow-up with regular visits. [Extracted from the article]