title: Vascular endothelial growth factor in patients with exudative age-related macular degeneration treated with ranibizumab.
abstract: OBJECTIVE
  To analyze the temporal correlations of vascular endothelial growth factor (VEGF) suppression, morphologic recurrence of choroidal neovascularization (CNV), and visual acuity loss in eyes with exudative age-related macular degeneration (AMD) treated with ranibizumab.
  
  
  METHODS
  Nonrandomized, prospective, clinical study.
  
  
  METHODS
  Forty-seven eyes of 47 patients with exudative AMD undergoing intravitreal ranibizumab injections.
  
  
  METHODS
  Aqueous humor specimens were taken before each intravitreal ranibizumab injection. Visual acuity testing, spectral domain optical coherence tomography (SD-OCT), and fundoscopy were performed before each injection. Vascular endothelial growth factor A was measured by Luminex multiplex bead analysis (Luminex Inc., Austin, TX).
  
  
  METHODS
  Intraocular VEGF concentration, recurrence of CNV activity shown by SD-OCT, and vision loss.
  
  
  RESULTS
  Ranibizumab resulted in complete VEGF suppression within a mean period of 37.8 days (standard deviation [SD] ± 4.8 days; range, 26-49 days). Recurrences of CNV activity as determined by SD-OCT occurred 93.7 days (SD ± 69.9 days; range, 57-368 days) after the last ranibizumab treatment. The VEGF levels were never suppressed when a recurrence occurred. Functional recurrence (visual acuity) occurred 114.3 days (SD ± 81.4 days; range, 57-398 days) after previous treatment. The VEGF levels did not differ significantly between baseline and recurrence (69.3 pg/ml vs. 74.14 pg/ml; 95% confidence interval, -18.87 to 9.12).
  
  
  CONCLUSIONS
  A monthly intravitreal injection of 0.5 mg ranibizumab yields a durable VEGF inhibition. The recurrences of CNV as determined by SD-OCT are always preceded by a loss of intraocular VEGF suppression and usually followed by loss of visual acuity in the further course.
authors.affiliation: Department of Vitreoretinal Surgery, Center of Ophthalmology, University of Cologne, Cologne, Germany.
authors.forename: Philipp S
authors.initials: PS
authors.lastname: Muether
authors.forename: Manuel M
authors.initials: MM
authors.lastname: Hermann
authors.forename: Ulrike
authors.initials: U
authors.lastname: Viebahn
authors.forename: Bernd
authors.initials: B
authors.lastname: Kirchhof
authors.forename: Sascha
authors.initials: S
authors.lastname: Fauser
mesh_terms: D000368:Aged; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage / Q000627:therapeutic use*; D001082:Aqueous Humor / Q000378:metabolism*; D020256:Choroidal Neovascularization / Q000188:drug therapy / Q000378:metabolism; D005122:Exudates and Transudates; D006801:Humans; D058449:Intravitreal Injections; D008163:Luminescent Measurements; D009887:Ophthalmoscopy; D011446:Prospective Studies; D000069579:Ranibizumab; D012008:Recurrence; D041623:Tomography, Optical Coherence; D042461:Vascular Endothelial Growth Factor A / Q000378:metabolism*; D014792:Visual Acuity / Q000502:physiology; D057135:Wet Macular Degeneration / Q000188:drug therapy* / Q000378:metabolism
chemical_list: D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D000069579:Ranibizumab