Date of Award

1-5-2009

Document Type

Thesis

Degree Name

Medical Doctor (MD)

First Advisor

Ron Adelman

Abstract

To study central macular thickness (CMT) and visual acuity (VA) changes in a series of patients with age-related macular degeneration (AMD) treated with ranibizumab alone versus those treated in combination with bevacizumab, pegaptanib sodium or photodynamic therapy (PDT). Retrospective study of patients treated at the Yale Eye Center. CMT and VA measurements were recorded at the initial injection of ranibizumab and at 1, 3, 6, 9 and 12 months. Fifty-eight eyes of 53 patients received ranibizumab therapy. They had a mean initial VA of 20/320 (logMAR 1.2) and CMT of 294 μm. At 12 months, the VA was 20/250 (logMAR 1.1) and CMT decreased to 255 μm. A mean of 6 ranibizumab injections/year were given and the mean follow-up was 10.2 months. Injections were given on a monthly basis for the first 3 months and then as needed based on optical coherence tomography (OCT). Twenty-four of these eyes received ranibizumab as the only anti-angiogenic agent, 18 eyes had prior pegaptanib injections to ranibizumab, 8 eyes had prior bevacizumab injections and 8 patients had pegaptanib and bevacizumab prior to starting ranibizumab. Eight eyes had pegaptanib only and 61 eyes had PDT only. Patients who received ranibizumab alone experienced stabilization of VA and CMT decreased significantly at 3 and 12-month follow-up. Patients treated with pegaptanib and bevacizumab prior to ranibizumab demonstrated a similar response. OCT is useful in following therapy response and determining the need for re-injection.

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