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Ranibizumab intravítreo en neovascularización coroidea secundaria a distrofia foveomacular viteliforme del adulto Intravitreal ranibizumab for choroidal neovascularisation associated with adult-onset vitelliform dystrophy
E. Prieto-Calvo,C. Torrón-Fernández Blanco,C. Egea-Estopi?án,N. Güerri-Monclús
Archivos de la Sociedad Espa?ola de Oftalmología , 2012,
Abstract: Caso clínico: Varón de 70 a os diagnosticado de distrofia foveomacular viteliforme del adulto (DFVA) que en el curso de su enfermedad presenta disminución brusca de visión en el ojo izquierdo coincidiendo con la aparición de una membrana neovascular oculta. Dada la localización yuxtafoveal de la membrana, se decidió tratar con ranibizumab intravítreo, siendo necesarias 2 inyecciones para lograr el cierre completo de la lesión neovascular. Discusión: El uso de ranibizumab intravítreo puede ser una opción de tratamiento eficaz en la neovascularización coroidea secundaria a DFVA, y se precisan series de casos más amplias para poder confirmar esta observación. Case report: A 70-year-old male patient diagnosed with bilateral adult-onset vitelliform dystrophy presented with a sudden decrease of vision in his left eye associated with the appearance of an occult type of neovascular membrane. It was treated with intravitreal ranibizumab due to juxtafoveal location of the membrane. Two injections were needed to induce total regression of the lesion. Discussion: Intravitreal ranibizumab may be effective to induce morphological and functional improvement in cases of choroidal neovascularization secondary to adult-onset vitelliform foveomacular dystrophy. Further case series are required to confirm this observation.
Single intravitreal ranibizumab for myopic choroidal neovascularization
Nor-Masniwati S, Shatriah I, Zunaina E
Clinical Ophthalmology , 2011, DOI: http://dx.doi.org/10.2147/OPTH.S21057
Abstract: gle intravitreal ranibizumab for myopic choroidal neovascularization Case report (3092) Total Article Views Authors: Nor-Masniwati S, Shatriah I, Zunaina E Published Date August 2011 Volume 2011:5 Pages 1079 - 1082 DOI: http://dx.doi.org/10.2147/OPTH.S21057 Saidin Nor-Masniwati, Ismail Shatriah, Embong Zunaina Department of Ophthalmology, Universiti Sains Malaysia, Kelantan, Malaysia Abstract: We report a case of myopic choroidal neovascularization that showed improvement after a single injection of ranibizumab. A 45-year-old Chinese man with high myopia presented with sudden onset painless central scotoma of his right eye of 2 weeks’ duration. There was no history of trauma. His right eye vision on presentation was 6/30 which showed no improvement with pinhole. The right fundus showed myopic maculopathy at the posterior pole with subretinal hemorrhage at the inferotemporal fovea. The optic disc was tilted with inferotemporal peripapillary atrophy. There was a myopic maculopathy appearance in the macula of the left eye. Fundus fluorescein angiography revealed choroidal neovascularization at the fovea of the right eye. A diagnosis of right eye choroidal neovascularization secondary to myopic maculopathy was made. A single intravitreal injection of ranibizumab 0.05 mL was given. Ten weeks following intravitreal injection, vision had improved to 6/7.5, and repeated fundus fluorescein angiography showed absence of choroidal neovascularization. Follow-up at 6 months showed visual acuity had normalized to 6/6 with glasses, which was maintained up to 12 months following treatment. The right fundus showed no further subretinal hemorrhage with no new lesions.
Single intravitreal ranibizumab for myopic choroidal neovascularization  [cached]
Nor-Masniwati S,Shatriah I,Zunaina E
Clinical Ophthalmology , 2011,
Abstract: Saidin Nor-Masniwati, Ismail Shatriah, Embong ZunainaDepartment of Ophthalmology, Universiti Sains Malaysia, Kelantan, MalaysiaAbstract: We report a case of myopic choroidal neovascularization that showed improvement after a single injection of ranibizumab. A 45-year-old Chinese man with high myopia presented with sudden onset painless central scotoma of his right eye of 2 weeks’ duration. There was no history of trauma. His right eye vision on presentation was 6/30 which showed no improvement with pinhole. The right fundus showed myopic maculopathy at the posterior pole with subretinal hemorrhage at the inferotemporal fovea. The optic disc was tilted with inferotemporal peripapillary atrophy. There was a myopic maculopathy appearance in the macula of the left eye. Fundus fluorescein angiography revealed choroidal neovascularization at the fovea of the right eye. A diagnosis of right eye choroidal neovascularization secondary to myopic maculopathy was made. A single intravitreal injection of ranibizumab 0.05 mL was given. Ten weeks following intravitreal injection, vision had improved to 6/7.5, and repeated fundus fluorescein angiography showed absence of choroidal neovascularization. Follow-up at 6 months showed visual acuity had normalized to 6/6 with glasses, which was maintained up to 12 months following treatment. The right fundus showed no further subretinal hemorrhage with no new lesions.Keywords: myopia, choroidal neovascularization, antivascular endothelial growth factor
Choroidal thickness after intravitreal ranibizumab injections for choroidal neovascularization  [cached]
Ellabban AA,Tsujikawa A,Ogino K,Ooto S
Clinical Ophthalmology , 2012,
Abstract: Abdallah A Ellabban, Akitaka Tsujikawa, Ken Ogino, Sotaro Ooto, Kenji Yamashiro, Akio Oishi, Nagahisa YoshimuraDepartment of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, JapanPurpose: To study changes in choroidal thickness with ranibizumab treatment for choroidal neovascularization (CNV).Design: Prospective case series.Methods: This prospective study consisted of 60 CNV-affected eyes of 60 patients treated with intravitreal injections of ranibizumab using an on-demand protocol after an initial loading phase. The eyes studied included 20 with age-related macular degeneration (AMD), 20 with polypoidal choroidal vasculopathy (PCV), and 20 with myopic CNV. In the eyes with AMD and PCV, choroidal thickness at the fovea was measured with optical coherence tomography using enhanced depth imaging. In eyes with myopic CNV, the choroidal thickness was measured using standard optical coherence tomography without the enhanced depth imaging technique.Results: With ranibizumab treatment, central retinal thickness decreased significantly (P < 0.001) and visual acuity improved significantly (P < 0.001). However, central choroidal thickness (167.2 ± 108.3 μm) showed no significant change at 1 month after the loading phase (165.2 ± 107.8 μm, P = 0.120) or at final examination (164.8 ± 107.7 μm, P = 0.115). At baseline, central retinal thickness in eyes with AMD was significantly greater that those with PCV (P = 0.005) or high myopia (P = 0.029). However, central choroidal thickness in eyes with myopic CNV was significantly thinner than in eyes with AMD (P < 0.001) or PCV (P < 0.001). In each type of disease, there was no significant change in central choroidal thickness with ranibizumab treatment.Conclusion: The effect of ranibizumab on the choroidal thickness is minimal, if any.Keywords: choroidal thickness, ranibizumab, optical coherence tomography
Choroidal thickness after intravitreal ranibizumab injections for choroidal neovascularization
Ellabban AA, Tsujikawa A, Ogino K, Ooto S, Yamashiro K, Oishi A, Yoshimura N
Clinical Ophthalmology , 2012, DOI: http://dx.doi.org/10.2147/OPTH.S30907
Abstract: roidal thickness after intravitreal ranibizumab injections for choroidal neovascularization Original Research (2745) Total Article Views Authors: Ellabban AA, Tsujikawa A, Ogino K, Ooto S, Yamashiro K, Oishi A, Yoshimura N Published Date May 2012 Volume 2012:6 Pages 837 - 844 DOI: http://dx.doi.org/10.2147/OPTH.S30907 Received: 15 February 2012 Accepted: 10 March 2012 Published: 30 May 2012 Abdallah A Ellabban, Akitaka Tsujikawa, Ken Ogino, Sotaro Ooto, Kenji Yamashiro, Akio Oishi, Nagahisa Yoshimura Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan Purpose: To study changes in choroidal thickness with ranibizumab treatment for choroidal neovascularization (CNV). Design: Prospective case series. Methods: This prospective study consisted of 60 CNV-affected eyes of 60 patients treated with intravitreal injections of ranibizumab using an on-demand protocol after an initial loading phase. The eyes studied included 20 with age-related macular degeneration (AMD), 20 with polypoidal choroidal vasculopathy (PCV), and 20 with myopic CNV. In the eyes with AMD and PCV, choroidal thickness at the fovea was measured with optical coherence tomography using enhanced depth imaging. In eyes with myopic CNV, the choroidal thickness was measured using standard optical coherence tomography without the enhanced depth imaging technique. Results: With ranibizumab treatment, central retinal thickness decreased significantly (P < 0.001) and visual acuity improved significantly (P < 0.001). However, central choroidal thickness (167.2 ± 108.3 μm) showed no significant change at 1 month after the loading phase (165.2 ± 107.8 μm, P = 0.120) or at final examination (164.8 ± 107.7 μm, P = 0.115). At baseline, central retinal thickness in eyes with AMD was significantly greater that those with PCV (P = 0.005) or high myopia (P = 0.029). However, central choroidal thickness in eyes with myopic CNV was significantly thinner than in eyes with AMD (P < 0.001) or PCV (P < 0.001). In each type of disease, there was no significant change in central choroidal thickness with ranibizumab treatment. Conclusion: The effect of ranibizumab on the choroidal thickness is minimal, if any.
A randomised, double-masked phase III/IV study of the efficacy and safety of Avastin? (Bevacizumab) intravitreal injections compared to standard therapy in subjects with choroidal neovascularisation secondary to age-related macular degeneration: clinical trial design
Praveen J Patel, Catey Bunce, Adnan Tufail, the ABC Trial Investigators
Trials , 2008, DOI: 10.1186/1745-6215-9-56
Abstract: The Avastin? (bevacizumab) for choroidal neovascularisation (ABC) trial is a double-masked randomised controlled trial comparing intravitreal bevacizumab injections to standard therapy in the treatment of nAMD. Patients are randomised to intravitreal bevacizumab or standard therapy available at the time of trial initiation (verteporfin photodynamic therapy, intravitreal pegaptanib or sham treatment). Ranibizumab treatment was not included in the control arm as it had not been licensed for use at the start of recruitment for this trial. The primary outcome is the proportion of patients gaining ≥ 15 letters of visual acuity at 1 year and secondary outcomes include the proportion of patients with stable vision and mean visual acuity change.The ABC Trial is the first double-masked randomised control trial to investigate the efficacy and safety of intravitreal bevacizumab in the treatment of nAMD. This trial fully recruited in November 2007 and results should be available in early 2009. Important design issues for this clinical trial include (a) defining the control group (b) use of gain in vision as primary efficacy end-point and (c) use of pro re nata treatment using intravitreal bevacizumab rather than continuous therapy.Current controlled trials ISRCTN83325075Age-related macular degeneration (AMD) is the leading cause of visual loss in patients over the age of 50 years in Europe and North America [1]. There are 2 forms of the disease with dry AMD and wet AMD (neovascular or exudative AMD). Neovascular age-related macular degeneration (nAMD) is characterised by choroidal neovascularisation (CNV) and is responsible for 75% of visual loss due to AMD despite only accounting for 25% of all cases [2].Historically the prognosis for patients with subfoveal nAMD has been poor with the established treatment of verteporfin photodynamic therapy (PDT) only showing modest efficacy in reducing visual loss in patients with well-defined (predominantly classic or classic no occult) su
Three Consecutive Monthly Intravitreal Ranibizumab for Choroidal Neovascularization in Central Serous Choriorethinopathy: A Case Report  [PDF]
Kazim Erol, Esin Sogutlu Sari, Arif Koytak, A Kara?or, D. T. ?oban, M. Bulut
Open Journal of Ophthalmology (OJOph) , 2012, DOI: 10.4236/ojoph.2012.23020
Abstract: Purpose: The author report the result of three consecutive monthly intravitreal ranibizumab injection for choroidal neovascularization (CNV) after bevacizumab injection for chronic central serous rethinopathy (CSR). Methods: A 48 year old man with chronic CSR was treated with intravitreal single dose 2.5 mg bevacizumab. One year after CNV was occurred, and three consecutive monthly intravitreal ranibizumab injections were performed. Results: Four weeks later the first ranibizumab dose, best corrected visual acuity was improved 20/80 to 20/20 and remained stable within one year. Conclusion: Repeat intravitreal ranibizumab injection in CNV after bevacizumab injection for chronic CSR appeared to be an effective treatment option.
Verteporfin Photodynamic Therapy Combined with Intravitreal Ranibizumab for Polypoidal Choroidal Vasculopathy Controversy Concerning Long-Term Followup
Maribel Fernández,María Gil,Francisco Gomez-Ulla,Pablo Charlón
Case Reports in Medicine , 2012, DOI: 10.1155/2012/897097
Abstract: Purpose. To show the long-term results of intravitreal ranibizumab combined with photodynamic therapy (PDT) for the treatment of polypoidal choroidal vasculopathy (PCV). Methods. We analyzed the progress of two patients for 36 and 58 months, respectively. We only used PDT for the treatment in the area of the active PCV or “hot spot” evident on the indocyanine green angiography (ICGA). The spot size was chosen so as to cover only the active neovascular lesion. We combined intravitreal ranibizumab with PDT when PCV remained active without visible polyps in ICGA or without a response to PDT. Conclusion. Administration, as required, of verteporfin photodynamic therapy combined with intravitreal ranibizumab is an effective treatment for symptomatic polypoidal choroidal vasculopathy. These data need to be confirmed in large, prospective, and controlled clinical trials which are randomized and carried out over a long period.
Intravitreal ranibizumab for symptomatic drusenoid pigment epithelial detachment without choroidal neovascularization in age-related macular degeneration
Roberto Gallego-Pinazo, Ana Marina Suelves-Cogollos, Ester Francés-Mu oz, et al
Clinical Ophthalmology , 2011, DOI: http://dx.doi.org/10.2147/OPTH.S15832
Abstract: travitreal ranibizumab for symptomatic drusenoid pigment epithelial detachment without choroidal neovascularization in age-related macular degeneration Original Research (4175) Total Article Views Authors: Roberto Gallego-Pinazo, Ana Marina Suelves-Cogollos, Ester Francés-Mu oz, et al Published Date February 2011 Volume 2011:5 Pages 161 - 165 DOI: http://dx.doi.org/10.2147/OPTH.S15832 Roberto Gallego-Pinazo1,2, Ana Marina Suelves-Cogollos1, Ester Francés-Mu oz1, J María Millán2,3, J Fernando Arevalo4, J Luis Mullor5, Manuel Díaz-Llopis1,2,6 1Department of Ophthalmology, Hospital Universitario La Fe, Valencia, Spain; 2Centro de Investigación Biomédica en Red de Enfermedades Raras, Valencia, Spain; 3Department of Genetics, Hospital Universitario La Fe, Valencia, Spain; 4Retina and Vitreous Service, Clínica Oftalmológica Centro Caracas, Caracas, Venezuela; 5Unit of Experimental Ophthalmology, Fundación para la Investigación del Hospital Universitario La Fe, Valencia, Spain; 6University of Valencia, Faculty of Medicine, Valencia, Spain Background: The aim of our study was to evaluate the functional and anatomic outcomes of intravitreal ranibizumab for the treatment of symptomatic drusenoid pigment epithelial detachment without choroidal neovascularization in age-related macular degeneration. Methods: This was a prospective, single-center, uncontrolled, interventional pilot study. Six consecutive eyes (six patients) with drusenoid pigment epithelial detachment with a visual acuity of 20/63 to 20/100 and no evidence of choroidal neovascularization in age-related macular degeneration participated. Patients were given at least one intravitreal ranibizumab injection and were followed for a mean of 66.67 ± 10.3 weeks. Main outcome measures included best-corrected visual acuity (BCVA) measured by Early Treatment Diabetic Retinopathy Study charts and optical coherence tomography, and central macular thickness measured by optical coherence tomography. Results: The mean number of intravitreal ranibizumab injections was 3.0 at the end of follow-up. Regarding BCVA and optical coherence tomography, 33.3% of eyes gained between 19 and 21 letters of BCVA, with a median decrease in central macular thickness of 21 μm. There was a statistically significant difference between baseline and final BCVA (P = 0.046). There was a positive correlation between intraretinal fluid by optical coherence tomography and improved BCVA after intravitreal ranibizumab. Metamorphopsia disappeared completely after the first injection in all subjects, with no further recurrences. No patient developed choroidal neovascularization or atrophic changes. Conclusion: Intravitreal ranibizumab demonstrated anatomic and functional benefit in patients with symptomatic drusenoid pigment epithelial detachment without choroidal neovascularization in age-related macular degeneration. Further long-term, randomized, controlled trials should be performed to confirm our preliminary results.
Verteporfin Photodynamic Therapy Combined with Intravitreal Ranibizumab for Polypoidal Choroidal Vasculopathy Controversy Concerning Long-Term Followup  [PDF]
Maribel Fernández,María Gil,Francisco Gomez-Ulla,Pablo Charlón
Case Reports in Medicine , 2012, DOI: 10.1155/2012/897097
Abstract: Purpose. To show the long-term results of intravitreal ranibizumab combined with photodynamic therapy (PDT) for the treatment of polypoidal choroidal vasculopathy (PCV). Methods. We analyzed the progress of two patients for 36 and 58 months, respectively. We only used PDT for the treatment in the area of the active PCV or “hot spot” evident on the indocyanine green angiography (ICGA). The spot size was chosen so as to cover only the active neovascular lesion. We combined intravitreal ranibizumab with PDT when PCV remained active without visible polyps in ICGA or without a response to PDT. Conclusion. Administration, as required, of verteporfin photodynamic therapy combined with intravitreal ranibizumab is an effective treatment for symptomatic polypoidal choroidal vasculopathy. These data need to be confirmed in large, prospective, and controlled clinical trials which are randomized and carried out over a long period. 1. Introduction Age-related macular degeneration (AMD) is the main cause of visual loss in the elderly population in industrial countries [1]. Exudative AMD is subcategorized into three phenotypes: typical AMD, polypoidal choroidal vasculopathy (PCV), and retinal angiomatous proliferation [1] but doubt still exists as to whether PVC is a distinct entity or a variant of neovascular AMD and other neovascularized maculopathies [2]. PCV is characterized by choroidal vascular networks with polyp-like aneurysmal dilations which are most clearly identified by indocyanine green angiography (ICGA) [3]. Fluorescein angiography (FA) and optical coherence tomography (OCT) are useful diagnostic tools [4]. In OCT, PCV is characterized by a higher incidence of retinal pigment epithelial detachment (PED), subretinal fluid, and less intraretinal fluid than eyes with exudative AMD [4]. PCV lesions appear as occult or minimally classic choroidal neovascularization (CNV) with FA, while ICGA clearly demonstrates the poly-like vascular network within the choroid. ICGA is the gold standard for the ultimate confirmation of PCV and it shows that the abnormal vasculature consists of a branching vascular network (BVN) and polypoidal lesions. Therefore, ICGA is the best way to diagnose PCV and to identify active components [5]. The visual prognosis of PVC has been reported to be better than that of exudative AMD, and a conservative approach is recommended, unless the lesion is associated with persistent or progressive exudative change that threatens central vision [6]. However, subretinal fibrosis and RPE atrophy can cause significant and permanent vision loss [7].
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