title: Intravitreal ranibizumab for the treatment of fibrovascular pigment epithelial detachment in age-related macular degeneration.
abstract: OBJECTIVE
  To determine the response of predominantly fibrovascular pigment epithelial detachments (PED)-type lesions (secondary to age-related macular degeneration [AMD]) to intravitreal ranibizumab.
  
  
  METHODS
  This was an open-label prospective study.
  
  
  METHODS
  Thirty-two patients with predominantly fibrovascular PED-type lesions secondary to AMD were included in this study. Three patients were excluded from the final analysis.
  
  
  METHODS
  Patients received monthly intravitreal ranibizumab injections for 6 months (induction). At 6 months, patients not experiencing a visual improvement from baseline Early Treatment of Diabetic Retinopathy Study (ETDRS) visual acuity or not showing a reduction in PED height (based on optical coherence tomography [OCT]) were deemed ranibizumab nonresponders and received no further injections but underwent re-evaluation at 12 months. Patients deemed responders continued with OCT-guided active treatment on an as-needed basis for an additional 6 months.
  
  
  RESULTS
  Twenty-four patients (82.8%) were ranibizumab responders and 5 were (17.2%) nonresponders. For ranibizumab responders, mean ETDRS visual acuity improved by 7.2 ± 9.8 letters at 6 months (p = 0.002) and 6.3 ± 8.6 letters at 12 months (p = 0.002). Ranibizumab nonresponders experienced a decline in mean visual acuity of 8.2 ± 4.6 letters at 6 months (p = 0.02) and 18.2 ± 10.11 letters at 12 months (p = 0.02). At baseline, responders had a mean PED height of 345.8 ± 96.0 μm, which decreased to 111.6 ± 133.2 μm at 6 months (p < 0.001) and had a slight increase at 12 months to 144.8 ± 146.3 μm (p < 0.001). Two responders (8.3%) and 2 nonresponders (40%) developed retinal pigment epithelium tears while on treatment.
  
  
  CONCLUSIONS
  Intravitreal ranibizumab appears to be a well-tolerated treatment option for patients with fibrovascular PED. Further large-scale, prospective studies may assist in delineating the best treatment protocol.
authors.affiliation: Ivey Eye Institute, Department of Ophthalmology, Western University, London.
authors.forename: Yiannis
authors.initials: Y
authors.lastname: Iordanous
authors.affiliation: Ivey Eye Institute, Department of Ophthalmology, Western University, London.
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Powell
authors.affiliation: Ivey Eye Institute, Department of Ophthalmology, Western University, London.
authors.forename: Alex
authors.initials: A
authors.lastname: Mao
authors.affiliation: Ivey Eye Institute, Department of Ophthalmology, Western University, London.
authors.forename: Philip L
authors.initials: PL
authors.lastname: Hooper
authors.affiliation: Ophthalmology and Vision Sciences, Sunnybrook Heath Sciences Centre, Toronto, Ont.
authors.forename: Kenneth T
authors.initials: KT
authors.lastname: Eng
authors.affiliation: Ophthalmology and Vision Sciences, Sunnybrook Heath Sciences Centre, Toronto, Ont.
authors.forename: Carol
authors.initials: C
authors.lastname: Schwartz
authors.affiliation: Ophthalmology and Vision Sciences, Sunnybrook Heath Sciences Centre, Toronto, Ont.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Kertes
authors.affiliation: Ivey Eye Institute, Department of Ophthalmology, Western University, London. Electronic address: sheidowt@rogers.com.
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Sheidow
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D005260:Female; D005355:Fibrosis; D005451:Fluorescein Angiography; D006801:Humans; D058449:Intravitreal Injections; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D000069579:Ranibizumab; D012163:Retinal Detachment / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D055213:Retinal Pigment Epithelium / Q000473:pathology; D041623:Tomography, Optical Coherence; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014792:Visual Acuity; D057135:Wet Macular Degeneration / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology
chemical_list: D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D000069579:Ranibizumab