title: Incidence of outer retinal tubulation in ranibizumab-treated age-related macular degeneration.
abstract: OBJECTIVE
  To investigate the incidence of outer retinal tubulation (ORT) in ranibizumab-treated neovascular age-related macular degeneration patients.
  
  
  METHODS
  We included 480 consecutive patients (546 eyes) with neovascular age-related macular degeneration, who were treated with variable-dosing intravitreal ranibizumab, evaluated with spectral domain optical coherence tomography, and followed-up for a minimum period of 6 months. Optical coherence tomographies were evaluated for the first appearance of ORT, precursor signs, and type of underlying lesion. Visual acuity was also recorded.
  
  
  RESULTS
  Outer retinal tubulation was observed in 30% of eyes during a mean follow-up period of 26.7 months (SD, 13.5). Kaplan-Meier survival analysis revealed that the ORT incidence (2.5, 17.5, 28.4, and 41.6% at baseline, after 1, 2, and 4 years, respectively) continuously increased, despite visually effective anti-vascular endothelial growth factor treatment. Outer retinal tubulation was associated with a poorer functional benefit. Lower baseline visual acuity was associated with a higher risk of developing ORT.
  
  
  CONCLUSIONS
  Incidence of ORT continuously increases despite visually optimal anti-vascular endothelial growth factor treatment of age-related macular degeneration. Outer retinal tubulation might be considered a prognostic factor for functional outcome and is relevant to avoid overtreatment.
authors.affiliation: Department of Ophthalmology, University of Lausanne, Lausanne, Switzerland; and Jules Gonin Eye Hospital, Fondation Asile des Aveugles (Foundation Asylum for the Blind), Lausanne, Switzerland.
authors.forename: Ali
authors.initials: A
authors.lastname: Dirani
authors.forename: Christina
authors.initials: C
authors.lastname: Gianniou
authors.forename: Laetitia
authors.initials: L
authors.lastname: Marchionno
authors.forename: Doris
authors.initials: D
authors.lastname: Decugis
authors.forename: Irmela
authors.initials: I
authors.lastname: Mantel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D058449:Intravitreal Injections; D008297:Male; D020419:Photoreceptor Cells, Vertebrate / Q000473:pathology*; D000069579:Ranibizumab; D019233:Retreatment; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014792:Visual Acuity / Q000502:physiology; D057135:Wet Macular Degeneration / 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