Subfoveal Choroidal Thickness after Ranibizumab Therapy for Neovascular Age-related Macular Degeneration: 12-Month Results

Purpose: To investigate the changes in subfoveal choroidal thickness after intravitreal injections of ranibizumab (IVRs) for neovascular age-related macular degeneration (AMD). Design: Prospective, consecutive, interventional case series. Participants: Eighty eyes (40 affected eyes with neovascular AMD and 40 unaffected fellow eyes) of 40 patients. Methods: Forty eyes with neovascular AMD were treated with 0.5-mg IVRs monthly for 3 months and received additional IVRs as needed over the following 9-month period. Subfoveal choroidal thickness in all 80 eyes was measured by use of enhanced depth imaging optical coherence tomography images before and after starting the IVRs. Main Outcome Measures: Changes in subfoveal choroidal thickness after treatment by IVRs over a 12-month period. Results: Twenty-three eyes (57.5%) were diagnosed with typical neovascular AMD, 16 eyes (40%) were diagnosed with polypoidal choroidal vasculopathy, and 1 eye (2.5%) was diagnosed with retinal angiomatous proliferation. Fifteen eyes (38%) had received some previous treatments for the neovascular lesion before undergoing the IVRs. The mean best-corrected visual acuity of the affected eyes was improved from 0.54 logarithm of the minimum angle of resolution units at baseline to 0.42 at 12 months (P = 0.020). The mean subfoveal choroidal thickness in the affected eyes decreased from 244 +/- 62 mu m at baseline to 234 +/- 66 mu m at 1 month (P = 0.013), 226 +/- 68 mu m at 3 months (P<0.001), 229 +/- 67 mu m at 6 months (P = 0.002), and 226 +/- 66 mu m at 12 months (P = 0.002; the change ratio, 93%), whereas that in the unaffected eyes changed from 237 +/- 80 mu m at baseline to 238 +/- 83 mu m at 12 months (P = 0.78). In the affected eyes, the change ratio of subfoveal choroidal thickness at 12 months was not correlated with the number of IVRs (mean, 5.8 +/- 2.9). Subfoveal choroidal thickness demonstrated a similar trend toward decreasing during the following period independent of the subtypes of neovascular AMD or the treatment histories. Conclusions: Subfoveal choroidal thickness decreased after IVRs in eyes with neovascular AMD. Intravitreal injections of ranibizumab may provide a pharmacologic effect not only on the neovascular lesion but also on the underlying choroid. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. Ophthalmology 2012;119:1621-1627 (C) 2012 by the American Academy of Ophthalmology.