title: Intravitreal ranibizumab for choroidal neovascularization secondary to gyrate atrophy in a young patient: a multimodal imaging analysis.
abstract: OBJECTIVE
  To present a case of choroidal neovascularization (CNV) due to gyrate atrophy (GA) treated with intravitreal ranibizumab.
  
  
  METHODS
  A 35-year-old man presented with sudden loss of vision and central scotoma in the right eye, as well as progressive night vision deterioration over the past several years in both eyes. His best-corrected visual acuity (BCVA) was 6/60 in the right eye and 6/5 in the left eye. Funduscopy revealed bilateral confluent areas of chorioretinal atrophy and optical coherence tomography showed subretinal fluid consistent with CNV development in the right eye, which was confirmed by fundus fluorescein angiography (FFA) and indocyanine green angiography (ICGA). The left eye was normal. The patient had a family history of GA. Elevated levels of plasma ornithine were detected, establishing the diagnosis.
  
  
  RESULTS
  The patient received a regimen of 3 monthly off-label intravitreal ranibizumab injections in the right eye. At the 6-month follow-up, no subretinal fluid was noticed and BCVA was 6/48. No other injections were performed, but the patient was advised to start an arginine-restricted diet and take vitamin B6 (pyridoxine) 300 mg daily. The BCVA was preserved and chorioretinal atrophy had not progressed on funduscopy, FFA, or ICGA 1 year later.
  
  
  CONCLUSIONS
  Intravitreal ranibizumab can offer promising anatomical and functional results, maintaining visual acuity in patients with CNV secondary to GA, especially if used in combination with arginine-restricted diet and vitamin B6 supplementation.
authors.affiliation: Retina Department, King's College Hospital, London - UK.
authors.forename: Irini
authors.initials: I
authors.lastname: Chatziralli
authors.affiliation: 2.
authors.forename: George
authors.initials: G
authors.lastname: Theodossiadis
authors.affiliation: 2.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Emfietzoglou
authors.affiliation: 2.
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Theodossiadis
mesh_terms: D000328:Adult; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D020256:Choroidal Neovascularization / Q000188:drug therapy* / Q000209:etiology*; D005451:Fluorescein Angiography; D015799:Gyrate Atrophy / Q000150:complications* / Q000178:diet therapy / Q000188:drug therapy; D006801:Humans; D058449:Intravitreal Injections; D008297:Male; D064847:Multimodal Imaging; D009887:Ophthalmoscopy; D000069579:Ranibizumab / Q000627:therapeutic use*; D058471:Subretinal Fluid; D041623:Tomography, Optical Coherence; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014792:Visual Acuity / Q000502:physiology; D025101:Vitamin B 6 / Q000627:therapeutic use; D014803:Vitamin B Complex / Q000627:therapeutic use
chemical_list: D020533:Angiogenesis Inhibitors; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D014803:Vitamin B Complex; D025101:Vitamin B 6; D000069579:Ranibizumab