title: Alterations of vascular pigment epithelium detachments associated with age-related macular degeneration during upload with intravitreal ranibizumab.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: *Department of Ophthalmology, Klinikum der Universität München, LMU, University Eye Hospital, Munich, Germany; †Department of Ophthalmology, University of Bonn, Bonn, Germany; and ‡Department of Ophthalmology, University of Muenster, Muenster, Germany.
authors.forename: Armin
authors.initials: A
authors.lastname: Wolf
authors.forename: Johann
authors.initials: J
authors.lastname: Rüping
authors.forename: Aljoscha S
authors.initials: AS
authors.lastname: Neubauer
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Mayer
authors.forename: Michael
authors.initials: M
authors.lastname: Ulbig
authors.forename: Christos
authors.initials: C
authors.lastname: Haritoglou
authors.forename: Frank G
authors.initials: FG
authors.lastname: Holz
authors.forename: Nicole
authors.initials: N
authors.lastname: Eter
authors.forename: Anselm
authors.initials: A
authors.lastname: Kampik
mesh_terms: D020533:Angiogenesis Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D058449:Intravitreal Injections; D008297:Male; D011446:Prospective Studies; D000069579:Ranibizumab; D012163:Retinal Detachment / Q000145:classification / Q000175:diagnosis / Q000188:drug therapy*; D055213:Retinal Pigment Epithelium / Q000187:drug effects* / Q000473:pathology; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014792:Visual Acuity / Q000187:drug effects / Q000502:physiology; D057135:Wet Macular Degeneration / Q000175:diagnosis / Q000188:drug therapy*
chemical_list: D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D000069579:Ranibizumab