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      Complete Resolution of a Giant Pigment Epithelial Detachment Secondary to Exudative Age-Related Macular Degeneration after a Single Intravitreal Ranibizumab (Lucentis) Injection: Results Documented by Optical Coherence Tomography

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          Abstract

          Aim:To describe a patient with a giant pigment epithelial detachment (PED) secondary to exudative age-related macular degeneration (ARMD) successfully treated with a single intravitreal ranibizumab (Lucentis) injection (0.5 mg/0.05 ml). Methods:An 89-year-old woman presented with a six-day history of reduced vision and distortion in the left eye. Best-corrected visual acuity in that eye was 6/15. Fundoscopy revealed a giant PED and exudates temporally to the fovea. Optical coherence tomography showed a PED associated with subretinal and intraretinal fluid. Fluorescein angiography confirmed the diagnosis of an occult choroidal neovascularization. Treatment with intravitreal injections of ranibizumab (Lucentis) was recommended, although the increased risk of retinal pigment epithelium (RPE) rip was mentioned. Results:Four weeks after the first intravitreal Lucentis injection, the visual acuity in the left eye improved to 6/7.5, with a significant improvement of the distortion and a complete anatomical resolution of the PED confirmed by optical coherence tomography. Conclusion:Giant PED secondary to exudative ARMD can be successfully treated with intravitreal ranibizumab, despite the increased risk of RPE rip. To our knowledge, this is the first case presenting with complete resolution of PED after a single ranibizumab injection.

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          Most cited references8

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          Tears of detached retinal pigment epithelium.

          K Sehmi, Gregory Bird, Mary Hoskin (1981)
          Ripping of detached pigment epithelium appears to be a common sight-threatening complication of pigment epithelial detachments and occurs at the junction of the detachment and flat pigment epithelium. The characteristics of the detachment prior to the rip suggest that the tear occurs in pigment epithelium which is detached without its basement membrane. The tear is followed by retraction of the pigment epithelium, revealing bare Bruch's membrane. The defect may remain apparently unaltered, or may be recovered by normal looking pigment epithelium, but most commonly is replaced by a fibrous plaque. Most patients had a profound reduction in visual acuity.
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            Retinal pigment epithelial tear after photodynamic therapy for choroidal neovascularization.

            Faik Gelisken, Werner Inhoffen, Michael Partsch … (2001)
            To report a case of retinal pigment epithelial tear after photodynamic therapy for choroidal neovascularization. Case report. A 74-year-old woman with exudative age-related macular degeneration and classic subfoveal choroidal neovascularization RE underwent photodynamic therapy with verteporfin. Ophthalmoscopy and fluorescein angiography RE disclosed a retinal pigment epithelial tear in the area of photodynamic therapy. This case presents the first report of a retinal pigment epithelial tear after photodynamic therapy with verteporfin for subfoveal choroidal neovascularization in age-related macular degeneration.
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              Intravitreally administered bevacizumab (Avastin) in minimally classic and occult choroidal neovascularization secondary to age-related macular degeneration.

              Ratimir Lazic, Nikica Gabric (2006)
              Anti-vascular endothelial growth factor (anti-VEGF) agents have been shown to be effective in the treatment of neovascular age-related macular degeneration (AMD). Efficacy and safety of intravitreally administered bevacizumab (Avastin), a humanized monoclonal anti-VEGF, was assessed in minimally classic and occult subfoveal choroidal neovascularization (CNV) due to AMD. A prospective interventional study was carried out. Bevacizumab (1.25 mg) was administered intravitreally on a 6-week basis until macular edema, subretinal fluid, and/or pigment epithelial detachment had resolved. Administration was repeated in case of relapse. Ophthalmic evaluations included a complete ophthalmic examination, measurement of the visual acuity (VA), optical coherence tomography, and fluorescein angiography. Main outcome measures were the changes between baseline and last follow-up visit in best-corrected VA, central foveal thickness (CFT) and total macular volume (TMV). From 102 patients [mean age (range) 74.8 (61-85) years], 102 eyes were included. Median (range) duration of follow-up was 18 (6-24) weeks. Statistically significant changes from baseline were observed in best-corrected VA [increase of 1.29 lines (P=0.001)], CFT [reduction of 56 microm (P=0.01)] and TMV [reduction of 0.80 mm(3) (P<0.0001)]. Positive results were obtained in 65/102 (64%) patients after two to three injections as a mean. In a substantial proportion of patients (38%) followed up for at least 18 weeks, recurrence of leakage requiring additional injections was observed. Treatment was well tolerated; two pigment epithelium rips and ten posterior vitreous detachments were reported. Short-term results suggest that intravitreally administered bevacizumab (Avastin) is effective in minimally classic and occult CNV due to AMD. Significant improvements in VA, CFT and TMV were obtained and maintained during follow-up. In some patients, however, recurrence of leakage requiring additional intravitreal injection occurred. Maintenance of the effect of bevacizumab and its safety after repeated and prolonged administration have to be investigated in well-controlled studies.
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                Author and article information

                Journal
                Journal ID (publisher-id): COP
                Journal ID (pmc): COP
                Journal ID (doi): 10.1159/issn.1663-2699
                Title: Case Reports in Ophthalmology
                Publisher: S. Karger AG
                ISSN (Electronic): 1663-2699
                Publication date Subscription-year: 2010
                Publication date Collection: September – December 2010
                Publication date (Electronic): 08 December 2010
                Volume: 1
                Issue: 2
                Pages: 110-113
                Affiliations
                Moorfields Eye Hospital, London, UK
                Author notes
                *Eleni Loukianou, MD, 25A Bavaria Road, Flat 8 Islington, N19 4EU London (UK), E-Mail eleniloukianou@yahoo.com
                Article
                Publisher ID: 321730 Pmcid ID: PMC3047744 Other ID: Case Rep Ophthalmol 2010;1:110–113
                DOI: 10.1159/000321730
                PMC ID: PMC3047744
                PubMed ID: 21373383
                SO-VID: 6b5d1043-f5c0-47ea-9143-9154f725fe34
                Copyright © © 2011 S. Karger AG, Basel
                License:

                Open Access License: This is an Open Access article licensed under the terms of the Creative Commons Attribution-NonCommercial 3.0 Unported license (CC BY-NC) ( http://www.karger.com/OA-license), applicable to the online version of the article only. Distribution permitted for non-commercial purposes only. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                History
                Page count
                Figures: 3, Pages: 4
                Categories
                Subject: Published: December 2010

                ScienceOpen disciplines: Vision sciences,Ophthalmology & Optometry,Pathology
                Keywords: Anti-VEGF,Age-related macular degeneration,Pigment epithelial detachment,Ranibizumab (Lucentis),Retinal pigment epithelium rip
                Data availability:
                ScienceOpen disciplines: Vision sciences, Ophthalmology & Optometry, Pathology
                Keywords: Anti-VEGF, Age-related macular degeneration, Pigment epithelial detachment, Ranibizumab (Lucentis), Retinal pigment epithelium rip

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