Intravitreal Ranibizumab for Pigment Epithelium Detachment With Subfoveal Occult Choroidal Neovascularization: A Prospective 24-Month Case Series

PURPOSE: To assess the effects of intravitreal ranibizumab injection in patients affected by pigment epithelial detachment associated with occult subfoveal choroidal neovascularization. DESIGN: Prospective, interventional case series. METHODS: Participants: Forty eyes of 40 patients were considered for the purpose of the study. Consecutive patients were recruited for a 24-month study. All patients underwent a complete ophthalmic examination, including best-corrected visual acuity on Early Treatment Diabetic Retinopathy Study (ETDRS) charts. After a 3-monthly loading phase, further intravitreal ranibizumab injections were administered on the basis of detection of any type of fluid on optical coherence tomography. Primary outcome measures: Changes in mean best-corrected visual acuity at 12 and 24 months and the proportion of eyes losing fewer than 15 letters (corresponding to 3 ETDRS lines) from baseline visual acuity. Secondary outcome measures: Changes in central macular thickness on optical coherence tomography and variation in mean area of the entire lesion. RESULTS: Forty patients were included. Mean best-corrected visual acuity decreased from 20/66 (58 ETDRS letters) to 20/83 (53 letters) at 12 months and 20/112 (489 ETDRS letters) at 24 months (P = .003). Eighty percent and 67.5% of eyes lost fewer than 3 lines at 12 and 24 months, respectively. Mean central macular thickness passed from 545 mu m to 428 mu m at 12 months and 426 mu m at 24 months. Mean lesion area changed from 6826 mu m(2) to 6312 mu m(2) at 12 months and 6010 mu m(2) at 24 months. CONCLUSIONS: The treatment of pigment epithelial detachment associated with occult subfoveal choroidal neovascularization with intravitreal ranibizumab injection after a 3-monthly loading phase and pro re nata strategy can lead to partial results over a 24-month follow-up. Further investigations are warranted to establish the best therapeutic approach to this disease. (Am J Ophthalmol 2013;155:103-108. (C) 2013 by Elsevier Inc. All rights reserved.)