Abstract
Background
The aim of this study is to evaluate the early visual impacts of various optical coherence tomographic (OCT) parameters after the first versus repeated intravitreal ranibizumab injection in patients with exudative age-related macular degeneration (AMD).
Methods
A retrospective comparative case series study was conducted on 20 eyes of 18 consecutive patients who received intravitreal ranibizumab injection for exudative AMD either for the first time (group 1; n = 8) with no prior anti-vascular endothelial growth factor (anti-VEGF) injection in the same or fellow eye, or for repeated times during the course of monthly injected ranibizumab (group 2; n = 12 eyes). The following baseline and 1 month post-injection data was collected for both groups and compared: best-corrected visual acuity (BCVA), qualitative and quantitative OCT parameters including: foveal thickness, foveal volume (central 1-mm circle), retinal volume at 3- and 5-mm central circles, retinal pigment epithelium (RPE) elevation, type of fluid collections, and type of AMD lesion. The size of the fluid and fibrovascular lesion (FVL) areas were measured using manual delineation and automatic calculation of the device. We made correlations between the post-injection visual acuity (VA) and each of post-injection OCT parameters in both groups and these were the main outcome measures.
Results
In group 1, there was a strong correlation between post-injection logarithm of minimum angle of resolution (logMAR) BCVA and each of the following: FVL size, foveal thickness, retinal volume at 3- and 5-mm central circles, RPE elevation, the size of the fluid area, and age of the patient (r > 0.70, p < 0.05), whereas in group 2; logMAR BCVA was strongly correlated only with foveal volume (r = 0.74, p = 0.01). Multivariate analysis showed that post-injection FVL size (r 2 = 0.69) and foveal volume (r 2 = 0.55) were the most important factors for VA 1 month following the initial and repeated ranibizumab injection, respectively.
Conclusions
The size of FVL and foveal volume showed a significant correlation with VA in AMD patients shortly after the first and repeated ranibizumab injection, respectively. Further studies with larger sample sizes are needed in order to support these results.
Similar content being viewed by others
References
Bressler NM, Bressler SB, Congdon NG, Ferris FL 3rd, Friedman DS, Klein R, Lindblad AS, Milton RC, Seddon JM (2003) Potential public health impact of age-related eye disease study results: AREDS Report No. 11. Arch Ophthalmol 121:1621–1624
Brown MM, Brown GC, Sharma S, Stein JD, Roth Z, Campanella J, Beauchamp GR (2006) The burden of age-related macular degeneration: a value-based analysis. Curr Opin Ophthalmol 17:257–266
Kahn HA, Leibowitz HM, Ganley JP, Kini MM, Colton T, Nickerson RS, Dawber TR (1977) The Framingham Eye Study I. Outline and major prevalence findings. Am J Epidemiol 106:17–32
Ferris FL III, Fine SL, Hyman L (1984) Age-related macular degeneration and blindness due to neovascular maculopathy. Arch Ophthalmol 102:1640–1642
Sayanagi K, Sharma S, Yamamoto T, Kaiser PK (2009) Comparison of spectral-domain versus time-domain optical coherence tomography in management of age-related macular degeneration with ranibizumab. Ophthalmology 116:947–955
Lopez PF, Sippy BD, Lambert HM, Thach AB, Hinton DR (1996) Transdifferentiated retinal pigment epithelial cells are immunoreactive for vascular endothelial growth factor in surgically excised age-related macular degeneration-related choroidal neovascular membranes. Invest Ophthalmol Vis Sci 37:855–868
Ip MS, Scott IU, Brown GC, Brown MM, Ho AC, Huang SS, Recchia FM (2008) Anti-vascular endothelial growth factor pharmacotherapy for age-related macular degeneration: a report by the American Academy of Ophthalmology. Ophthalmology 115(10):1837–1846
Kaiser PK, Blodi BA, Shapiro H, Acharya NR (2007) Angiographic and optical coherence tomographic results of the MARINA study of ranibizumab in neovascular age-related macular degeneration. Ophthalmology 114(10):1868–1875
Mordenti J, Cuthbertson RA, Ferrara N, Thomsen K, Berleau L, Licko V, Allen PC, Valverde CR, Meng YG, Fei DT, Fourre KM, Ryan AM (1999) Comparisons of the intraocular tissue distribution, pharmacokinetics, and safety of 125I-labeled full-length and Fab antibodies in rhesus monkeys following intravitreal administration. Toxicol Pathol 27:536–544
Chen Y, Wiesmann C, Fuh G, Li B, Christinger HW, McKay P, de Vos AM, Lowman HB (1999) Selection and analysis of an optimized anti-VEGF antibody: crystal structure of an affinity-matured Fab in complex with antigen. J Mol Biol 293:865–881
Houck KA, Leung DW, Rowland AM, Winer J, Ferrara N (1992) Dual regulation of vascular endothelial growth factor bioavailability by genetic and proteolytic mechanisms. J Biol Chem 267:26031–26037
Van de Moere A, Sandhu SS, Talks SJ (2006) Correlation of optical coherence tomography and fundus fluorescein angiography following photodynamic therapy for choroidal neovascular membrane. Br J Ophthalmol 90:304–306
Eter N, Spaide RF (2005) Comparison of fluorescein angiography and optical coherence tomography for patients with choroidal neovascularization after photodynamic therapy. Retina 25:691–696
Emerson MV, Lauer AK, Flaxel CJ, Wilson DJ, Francis PJ, Stout JT, Emerson GG, Schlesinger TK, Nolte SK, Klein ML (2007) Intravitreal bevacizumab (Avastin) treatment of neovascular age-related macular degeneration. Retina 27:439–444
Hayashi H, Yamashiro K, Tsujikawa A, Ota M, Otani A, Yoshimura N (2009) Association between foveal photoreceptor integrity and visual outcome in neovascular age-related macular degeneration. Am J Ophthalmol 148(1):83–89
Moutray T, Alarbi M, Mahon G, Stevenson M, Chakravarthy U (2008) Relationships between clinical measures of visual function, fluorescein angiographic and optical coherence tomography features in patients with subfoveal choroidal neovascularisation. Br J Ophthalmol 92(3):361–364
Keane PA, Liakopoulos S, Chang KT, Wang M, Dustin L, Walsh AC, Sadda SR (2008) Relationship between optical coherence tomography retinal parameters and visual acuity in neovascular age-related macular degeneration. Ophthalmology 115(12):2206–2214
Oishi A, Hata M, Shimozono M, Mandai M, Nishida A, Kurimoto Y (2010) The significance of external limiting membrane status for visual acuity in age-related macular degeneration. Am J Ophthalmol 150:27–32
Rosenfeld PJ, Brown DM, Heier JS, Boyer DS, Kaiser PK, Chung CY, Kim RY (2006) Ranibizumab for neovascular age-related macular degeneration. N Engl J Med 355:1419–1431
Augustin AJ, Puls S, Offermann I (2007) Triple therapy for choroidal neovascularization due to age-related macular degeneration: verteporfin PDT, bevacizumab, and dexamethasone. Retina 27:133–140
Krebs I, Binder S, Stolba U, Schmid K, Glittenberg C, Brannath W, Goll A (2005) Optical coherence tomography guided retreatment of photodynamic therapy. Br J Ophthalmol 89:1184–1187
Sahni J, Stanga P, Wong D, Harding S (2005) Optical coherence tomography in photodynamic therapy for subfoveal choroidal neovascularisation secondary to age related macular degeneration: a cross-sectional study. Br J Ophthalmol 89:316–320
Keane PA, Liakopoulos S, Ongchin SC, Heussen FM, Msutta S, Chang KT, Walsh AC, Sadda SR (2008) Quantitative subanalysis of optical coherence tomography after treatment with ranibizumab for neovascular age-related macular degeneration. Invest Ophthalmol Vis Sci 49(7):3115–3120
Witkin AJ, Vuong LN, Srinivasan VJ, Gorczynska I, Reichel E, Baumal CR, Rogers AH, Schuman JS, Fujimoto JG, Duker JS (2009) High-speed ultrahigh resolution optical coherence tomography before and after ranibizumab for age-related macular degeneration. Ophthalmology 116(5):956–963
Kiss CG, Geitzenauer W, Simader C, Gregori G, Schmidt-Erfurth U (2009) Evaluation of ranibizumab-induced changes in high-resolution optical coherence tomographic retinal morphology and their impact on visual function. Invest Ophthalmol Vis Sci 50(5):2376–2383
Strauss O (2005) The retinal pigment epithelium in visual function. Physiol Rev 85:845–881
Kiss CG, Barisani-Asenbauer T, Simader C, Maca S, Schmidt-Erfurth U (2008) Central visual field impairment during and following cystoid macular oedema. Br J Ophthalmol 92:84–88
Midena E, Vujosevic S, Convento E, Manfre A, Cavarzeran F, Pilotto E (2007) Microperimetry and fundus autofluorescence in patients with early age-related macular degeneration. Br J Ophthalmol 91:1499–1503
Tezel TH, Del Priore LV, Flowers BE, Grosof DH, Benenson IL, Zamora RL, Kaplan HJ (1996) Correlation between scanning laser ophthalmoscope microperimetry and anatomic abnormalities in patients with subfoveal neovascularization. Ophthalmology 103:1829–1836
Schneider U, Inhoffen W, Gelisken F, Kreissig I (1996) Assessment of visual function in choroidal neovascularization with scanning laser microperimetry and simultaneous indocyanine green angiography. Graefes Arch Clin Exp Ophthalmol 234:612–617
Author information
Authors and Affiliations
Corresponding author
Additional information
There is neither a financial relationship nor sponsorship with any organization to be declared. The authors have full control of all primary data and they agree to allow Graefe’s Archive for Clinical and Experimental Ophthalmology to review their data if request.
Electronic supplementary material
Below is the link to the electronic supplementary material.
ESM1
(DOC 24 kb)
Rights and permissions
About this article
Cite this article
Sayed, K.M., Naito, T., Nagasawa, T. et al. Early visual impacts of optical coherence tomographic parameters in patients with age-related macular degeneration following the first versus repeated ranibizumab injection. Graefes Arch Clin Exp Ophthalmol 249, 1449–1458 (2011). https://doi.org/10.1007/s00417-011-1672-2
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00417-011-1672-2