title: Optical coherence tomography and multifocal electroretinography of patients with advanced neovascular age-related macular degeneration before, during, and after treatment with ranibizumab.
abstract: OBJECTIVE
  To evaluate retinal morphology and function of patients with advanced neovascular age-related macular degeneration (AMD) before, during, and after treatment with ranibizumab.
  
  
  METHODS
  Twenty-one eyes diagnosed with advanced AMD were studied with optical coherence tomography (OCT) and multifocal electroretinography (mfERG). Three intravitreal injections of ranibizumab were administered at 1-month intervals. Evaluations were performed before the first injection (D0) and at 30 (D30), 60 (D60), and 90 days (D90) after the first injection and compared to an age-matched control group (n=21 eyes).
  
  
  RESULTS
  The thickness of macular retinal layers increased before treatment due to the presence of intraretinal fluid. A thick retinal pigment epithelium-choriocapillaris complex (RPE-CC) suggested the presence of choroidal neovascular membrane. Intraretinal edema decreased after treatment (P<0.01), but persisting RPE-CC thickness resulted in a subretinal scar. Three different annular retinal areas were studied with mfERG (from center to periphery: rings R1, R2, and R3). The amplitude of the first negative component (N1) decreased in R1, R2, and R3 at D30, D60, and D90 when compared with that in controls (P<0.05); the N1 implicit time was delayed in R3 at D30 (P<0.05). The amplitude of the first positive component (P1) was reduced in R1 and R2 at D30, D60, and D90 when compared with that in controls (P<0.01); the P1 implicit time was delayed in R1 at D0 and D60 (P<0.05), in R2 at D0, D30, and D90 (P<0.01), and in R3 at D30 and D60 (P<0.05).
  
  
  CONCLUSIONS
  Ranibizumab reduces intraretinal edema, even in advanced cases. Central macular activity appeared to increase after the initiation of treatment, improving over time.
authors.affiliation: Complexo Hospitalar Padre Bento de Guarulhos, São Paulo, SP, Brazil.
authors.forename: Izabela Negrão Frota de
authors.initials: IN
authors.lastname: Almeida
authors.affiliation: Instituto de Ciências Biológicas, Federal University of Pará, Belém, PA, Brazil.
authors.forename: Luciana Negrão Frota de
authors.initials: LN
authors.lastname: Almeida
authors.affiliation: Instituto de Ciências da Saúde, Federal University of Pará, Belém, PA, Brazil.
authors.forename: Edmundo Frota de
authors.initials: EF
authors.lastname: Almeida Sobrinho
authors.affiliation: Instituto de Ciências Biológicas, Federal University of Pará, Belém, PA, Brazil.
authors.forename: Bruno Duarte
authors.initials: BD
authors.lastname: Gomes
authors.affiliation: Instituto de Ciências Biológicas, Federal University of Pará, Belém, PA, Brazil.
authors.forename: Givago da Silva
authors.initials: Gda S
authors.lastname: Souza
authors.affiliation: Instituto de Ciências da Saúde, Federal University of Pará, Belém, PA, Brazil.
authors.forename: Alexandre Antonio Marques
authors.initials: AA
authors.lastname: Rosa
authors.affiliation: Instituto de Ciências Biológicas, Federal University of Pará, Belém, PA, Brazil.
authors.forename: Luiz Carlos L
authors.initials: LC
authors.lastname: Silveira
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D004596:Electroretinography / Q000379:methods; D005260:Female; D006801:Humans; D058449:Intravitreal Injections; D008268:Macular Degeneration / Q000188:drug therapy* / Q000503:physiopathology*; D008297:Male; D000069579:Ranibizumab; D015203:Reproducibility of Results; D012160:Retina / Q000187:drug effects* / Q000503:physiopathology*; D013997:Time Factors; D041623:Tomography, Optical Coherence / Q000379:methods; D016896:Treatment Outcome; D014792:Visual Acuity
chemical_list: D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; D000069579:Ranibizumab