Intravitreal ranibizumab for the treatment of fibrovascular pigment epithelial detachment in age-related macular degeneration

Objective: To determine the response of predominantly fibrovascular pigment epithelial detachments (PED)-type lesions (secondary to age-related macular degeneration [AMD]) to intravitreal ranibizumab. Design: This was an open-label prospective study. Participants: Thirty-two patients with predominantly fibrovascular FED-type lesions secondary to AMD were included in this study. Three patients were excluded from the final analysis. Methods: Patients received monthly intravitreal ranibizumab injections for 6 months (induction). At 6 months, patients not experiencing a visual improvement from baseline Early Treatment of Diabetic Retinopathy Study (ETDRS) visual acuity or not showing a reduction in FED height (based on optical coherence tomography [OCT]) were deemed ranibizumab nonresponders and received no further injections but underwent re-evaluation at 12 months. Patients deemed responders continued with OCT-guided active treatment on an as-needed basis for an additional 6 months. Results: Twenty-four patients (82.8%) were ranibizumab responders and 5 were (17.2%) nonresponders. For ranibizumab responders, mean ETDRS visual acuity improved by 7.2 +/- 9.8 letters at 6 months (p = 0.002) and 6.3 +/- 8.6 letters at 12 months (p = 0.002). Ranibizumab nonresponders experienced a decline in mean visual acuity of 8.2 +/- 4.6 letters at 6 months (p = 0.02) and 18.2 +/- 10.11 letters at 12 months (p = 0.02). At baseline, responders had a mean FED height of 345.8 +/- 96.0 mu m, which decreased to 111.6 +/- 133.2 mu m at 6 months (p < 0.001) and had a slight increase at 12 months to 144.8 +/- 146.3 mu m (p < 0.001). Two responders (8.3%) and 2 nonresponders (40%) developed retinal pigment epithelium tears while on treatment. Conclusions: Intravitreal ranibizumab appears to be a well-tolerated treatment option for patients with fibrovascular FED. Further large-scale, prospective studies may assist in delineating the best treatment protocol.