Intravitreal Ranibizumab in the Treatment of Predominantly Hemorrhagic Lesions in Exudative Age-Related Macular Degeneration

Zusammenfassung

Hintergrund: Submakuläre Blutungen sind eine Erscheinung der neovaskulären altersabhängigen Makuladegeneration (AMD) mit sehr schlechter Spontanprognose und Gefahr von schwerem Sehverlust. Wir untersuchen die Sicherheit und Wirksamkeit von intravitrealem Ranibizumab als Behandlung von vorwiegend hämorrhagischer AMD. Patienten und Methoden: Retrospektive Untersuchung von Patienten mit vorwiegend hämorrhagischer AMD, die mit intravitrealem Ranibizumab zwischen Dezember 2006 und Dezember 2008 im Jules Gonin Augenspital behandelt wurden. Die Erstuntersuchung sowie die monatlichen Folgeuntersuchungen beinhalteten Visus, Fundus, optische Kohärenztomografie (OCT), während Fluorescein- und Indocyaninangiografie alle 3 Monate durchgeführt wurden. Ergebnisse: 8 Augen waren eingeschlossen. Die mittlere Nachuntersuchungsdauer war 13 Monate (SD: 6,3). Die mittlere Anzahl intravitrealer Injektionen lag bei 6,4 (SD: 2). Die Hälfte der Patienten hatte stabilen oder verbesserten Visus. Die Ausdehnung der Blutung bei Erstuntersuchung war umgekehrt korreliert mit dem Endvisus (p = 0,038) und positiv korreliert mit der Enddicke der Makula (p = 0,021). Antikoagulation war umgekehrt assoziiert mit der Dauer bis zur Absorption der Blutung (p = 0,039). Schlussfolgerungen: Intravitreales Ranibizumab könnte eine effiziente Therapie für vorwiegend hämorrhagische Läsionen bei neovaskulärer AMD sein.

Abstract

Background: Submacular hemorrhage is a manifestation of neovascular age-related macular degeneration (AMD) that has a very poor natural history leading to severe visual loss. We have evaluated the safety and efficacy of intravitreal ranibizumab in the treatment of predominantly hemorrhagic AMD. Patients and Methods: A retrospective study of patients with predominantly hemorrhagic AMD treated with intravitreal ranibizumab at the Jules Gonin Eye Hospital between December 2006 and December 2008 was undertaken. Baseline and monthly follow-up exams included visual acuity (VA), fundus exam and optical coherence tomography (OCT) while fluorescein and indocyanine green angiography were performed at least every three months. Results: The study included 8 eyes. The mean follow-up was 13 months (SD: 6.3). The mean number of intravitreal injections administered for each patient was 6.4 (SD: 2). 50 % of the patients demonstrated stable or improved VA. The size of hemorrhage at baseline was inversely correlated to the final VA (two-tailed p value = 0.038) and positively correlated to the final central macular thickness (two-tailed p value = 0.021). Anticoagulation treatment was inversely correlated to the time of hemorrhage resolution (two-tailed p value = 0.039). Conclusions: Intravitreal ranibizumab may be an effective treatment for predominantly hemorrhagic lesions due to neovascular AMD.

Schlüsselwörter

intravitreales Ranibizumab - choroidale Neovaskularisation - vorwiegend hämorrhagische altersabhängige Makuladegeneration

Key words

intravitreal ranibizumab - choroidal neovascularization - predominantly hemorrhagic age-related macular degeneration

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