| Objective: exudative age-related macular degeneration (AMD) isSeparated into different groups by optical coherence tomography (OCT)performance, all patients were treated with intravitreal lucentis (ranibizumab)injection, were observed after treatment. To evaluate the short-term efficacyand safety of intravitreal lucentis in the treatment of age-relatedmaculardegeneration(AMD) and Whether there are differences.Methods: It was aseries of prospective study,Date of27patients(28eyes)with AMD,coming from The Second Hosptial of Hebei MedicalUniversity.They were from March，2012through，January2014were observed.And they were divided into two groups by OCT.One group is sub-RPEtype,the other one is CNV grew across the RPE and into thesub—retinalspace.Each group has14eyes. Every patient were examined thefundus,the Best correct visual acuity(BCVA), intraocularpressure (IOP),fundusfluorescein angiography (FFA),fundus indocyanine greenangiography(ICGA),and OCT before、 one week and per month afterintravitreal injection of lucentis. Every patient need intravitreal injection threetimes. After three times, patients need examined every month. The follow-uptime was6months. Every three month need examined FFA. Ophthalmicevaluation included BCVA,IOP, Retinal thickness of the lesions, fundusexaminations and complications. Compared BCVA,IOP, retinal thickness ateach time before and after treatment. The results before and after treatment toassess the therapeutic effect and re-treatment whether they were existence ofdifferences in the two groups.Results：1Best-correct visualacuity:Two groups get the best vision is after three times intravitreal injection. Before treatment the mean of BCVA is0.895±0.261in the sub-RPE type. the14eyes every month after each treatment the meanBCVA were:0.741±0.290,0.681+/0.281,0.529±0.279, they weresignificant compared with before treatment,(p=0.006,0.005,0.000, p<0.05).the group of CNV grew across the RPE patients’ mean BCVA beforetreatment1.172±0.062, one month after the treatment of the eye mean BCVAwere:0.959±0.237,0.908±0.770,0.898±0.231, compared with beforetreatment statistics show the difference (p=0.032,0.004,0.002, p <0.05). Thesame period in the two groups were statistically significant.The group of CNVgrew across the RPE patients Effectiveness come to92.86%.The sub-RPE typetotal effectiveness come to100%. Followed up to6months, final follow-upvisual acuity was0.925±0.470. Compared with before treatment64.29%ofpatients with vision acuity remained stable or improved. The other group finalfollow-up visual acuity:0.695±0.470. Compared to before treatment has85.72%patients maintained visual acuity stabilized or improved.2The sub-RPE type and the CNV grew across RPE before treatment themean retinal thickness was:600.71±166.43μm and431.28±85.14μm. theCNV grew across RPE patients retinal thickness at one month after eachtreatment were529.50±165.92μm,490.85±162.20μm,475.21±157.98μm.The other group retinal thickness after intravitreal injection were314.50±90.05μm、281.50±102.67μm、256.35±82.80μm. We can find retinalthickness decreased in both groups of patients during treatment. During thebasic of treatment the two groups of retinal thickness of were changed. theCNV grew across RPE patients retinal thickness has been changed by71.21±39.63μm、110.78±32.85μm、124.00±35.92μm;The CNV grew belowRPE patients has been changed by116.78±65.93μm、149.64±64.76μm、174.07±79.16μm. The same period in the two groups were statisticallysignificant(p<0.05).Accordance to before and after treatment both groups withthe rate of change: the sub-RPE type patient:27.47%,35.36%,43.43%, theCNV grew across RPE patients were:12.22%,19.22%,21.72%.The rate ofthese group were statistically significant(p<0.05). 3The sub-RPE type patients’ the Mean of lesion with pre-treatment4000.10±805.40μm, after the three times treatment, the mean lesion gets2008.50±1269.16μm.The CNV grew across RPE before treatment was4288.60±1215.29μm, after basic treatment of lesions decreased to3188.5±685.90μm. Lesion size compared two groups of patients before treatment werestatistically significant. Changes in patients between the two groups was nosignificant difference.4Re-treatment cases: The CNV grew across RPE patients:3patientsneed further treatment in the third month after treatment is completed.In thefourth month and the fifth month has found two case of re-treatment, the firstsixth month there have been four cases of re-treatment, including two cases forthe second re-treatment. From the end of treatment to the end of the six monthfollow-up, there are seven cases (50.00%) patients receiving re-treatment,2patients re-treatment two times,5patients treated once again, re-treatmentaverage1.28±0.49times.7patients re-treated only three patients haddecreased visual acuity or visual distortion of symptoms. The remaining fourcases are found by OCT, one case occured new lesions, three cases of retinaledema compared with the previous increase more than100μm.The group ofsub-RPE type, in the fourth month after treatment has2cases get retreatment,the fifth and the sixth month each have one case of re-treatment of patients.atthe end of the follow-up a total of four (28.57%) patients underwentre-treatment. Four patients were treated once again, re-treatment average1.0times. One patient OCT displayed edema between retinal layers,consciouslyvisual distortion. Three patients consciously decreased vision.5Adverse reactions and complications: Ophthalmic topical: a commoncomplication is3cases sub-conjunctival hemorrhage in local injection on thesecond day after the injection,2patients after injection appears flutteringshadows, were recove within a week. No patient experienced high intraocularpressure, endophthalmitis, hyphema, iridocyclitis, complicated cataract, retinalhemorrhage, retinal pigment epithelial tear, retinal detachment, choroidaldetachment and other adverse reactions. General condition: All patients in the treatment follow-up were not observed mental illness, neurological disorders,allergic reactions.Conclusion:1Lucentis is safe and effective to treat these two different types of exudativeAMD.2The CNVgrew below RPE’s therapeutic effect is better than the other type.3Early treatment can help restore vision, lower re-treatment rate.4closely follow-up, positive re-treatment, can effectively prevent vision loss. |
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