1. Clinical Features, Prognosis, and Long-Term Response to Ranibizumab of Macular CNVs in Pattern Dystrophies Spectrum: A Pilot Study
- Author
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Lorenzo Casillo, Enzo Maria Vingolo, Stefano Tricarico, and Laura Contento
- Subjects
medicine.medical_specialty ,Article Subject ,genetic structures ,pattern dystrophies (PD) ,ntravitreal ranibizumab ,Loading dose ,chemistry.chemical_compound ,Pro re nata ,Ophthalmology ,Medicine ,choroidal neovascularizations (CNVs) ,age-related macular degeneration (AMD) ,retinal pigment epithelium (RPE) ,adult-onset foveomacular vitelliform dystrophy (AOFVD) ,business.industry ,Retrospective cohort study ,Retinal ,RE1-994 ,Macular degeneration ,medicine.disease ,eye diseases ,medicine.anatomical_structure ,Choroidal neovascularization ,chemistry ,Choroid ,sense organs ,Ranibizumab ,medicine.symptom ,business ,medicine.drug ,Research Article - Abstract
Introduction. To analyze the morphological and functional features of choroidal neovascularizations (CNVs) in eyes affected by pattern dystrophies (PD), evaluating their long-term response to intravitreal ranibizumab, and comparing them with CNVs in age-related macular degeneration (AMD). The mean goal is to identify possible disease biomarkers and to evaluate the long-term prognosis of CNVs in PD. Materials and Methods. A retrospective study of 42 patients with naïve CNV (26 PD and 16 AMD), for a total of 47 eyes (29 eyes in the PD group and 18 eyes in the AMD group). Each patient received a loading dose of ranibizumab (one monthly for three months) followed by pro re nata (PRN) reinjection protocol for a period of at least three years. Morphological OCT parameters (CRT, central retinal thickness; SRF, subretinal fluid; IRF, intraretinal fluid; SHRM, subretinal hyperreflective material; HRF, hyperreflective foci; HCD, hyperreflective crystalline deposits; cCT, central choroidal thickness; slCT, sublesional choroidal thickness; EZd, ellipsoid zone disruption; and best corrected visual acuity (BCVA in logMAR scale)) were reported at baseline and last follow-up. Results. At baseline, no significant differences were found between the two groups, except for choroidal thickness parameters that were significantly greater in the PD group ( p = 0.009). Longitudinal PD analysis demonstrated reduction in BCVA ( p = 0.009), decrease in CRT ( p = 0.046), resolution of SRF in 61.6% of cases ( p = 0.004) and SHRM in 30% ( p = 0.034), and choroidal thinning both centrally ( p = 0.004) and sublesional ( p = 0.011) compared to baseline. At 3 years, the PD group received significantly more injections than the AMD ( p = 0.011) and showed significantly thicker choroid ( p = 0.033) and more frequent HRF ( p = 0.006). Regarding the PD group, we found a negative correlation between age and choroidal thicknesses at baseline and at 3 years ( p p p = 0.003) and SHRM at 3 years ( p = 0.003); CRT baseline and CRT 3 years ( p = 0.017); HCD at 3 years was associated with greater CRT ( p = 0.04) and IRF at 3 years ( p = 0.019). Conclusions. Early and long-term morphofunctional features of CNVs in PD and in AMD are overlapping. CNVs in PD have poorer long-term response to ranibizumab and higher choroidal thickness suggesting different pathogenetic and evolutionary mechanisms.
- Published
- 2020