Abstract
Purpose
To assess retinal vascular calibre changes in eyes with neovascular age-related macular degeneration (AMD), treated with intravitreal anti-vascular endothelial growth factor agents, over a 1-year period and compare any such changes to untreated fellow eyes.
Methods
Treatment naïve patients with neovascular AMD received three consecutive intravitreal injections of ranibizumab, followed by a pro re nata dosing regimen up to 1 year, with the aim of maintaining a ‘fluid-free’ macula. Retinal arteriolar and venular calibre was measured from digital fundus photographs at baseline and at three monthly intervals to 1 year, and summarised as central retinal artery equivalent (CRAE) and central retinal venular equivalent (CRVE), respectively.
Results
A total of 53 injected eyes and 41 fellow, non-injected eyes were analysed. At baseline, there were no differences in retinal vascular calibre between injected and non-injected eyes (mean CRAE (SD) 144.93 (14.07) vs 145.74 (13.10) μm, P=0.80 and mean CRVE (SD) 216.23 (25.93) vs 219.91 (22.82) μm, P=0.53). Over a 12-month period, retinal venular calibre dilatation occurred in injected eyes (mean CRVE change +5.71 (14.71) μm, P=0.007), with no change in retinal arterioles, +0.69 (14.71) μm, P=0.68. In non-injected eyes, arteriolar narrowing occurred as a whole, mean CRAE change −4.20 (7.00) μm, P=0.001, over 12 months, with a trend for narrowing in venules, −2.16 (11.56) μm, P=0.28. In injected eyes, after controlling for covariates, the changes in CRVE over 12 months mirrored improvements in macular thickness, −0.06 (−0.005, −0.11) μm, P=0.04, and visual acuity, +9.66 (−0.30, +19.32) μm, P=0.06.
Conclusion
Intravitreal ranibizumab significantly dilated retinal venules after a 1-year period.
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Acknowledgements
This study was partially funded by a National Health and Medical Research Council grant, 52993. Drs Guymer and Wong are on advisory boards of Novartis and Pfizer and have received research funding, speaking fees, travel and accommodation from either/both companies. The Centre for Eye Research Australia receives Operational Infrastructure Support from the Victorian Government. This study was approved by the Human Research and Ethics Committee of the Royal Victorian Eye and Ear Hospital (RVEEH).
Author contributions
SW, SQ, and TW designed and conducted the study. SW collected the data. SW and RG managed the data. Analysis was done by JX and RK; interpretation of the data was done by SW, RG, TW, and SQ; and preparation by SW, TW, and RG. Review or approval of the manuscript was done by RG, TW, and SQ.
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Dr Wickremasinghe was supported by a Novartis fellowship during the 2008/9 period. The remaining authors declare no conflict of interest.
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Wickremasinghe, S., Xie, J., Guymer, R. et al. Retinal vascular changes following intravitreal ranibizumab injections for neovascular AMD over a 1-year period. Eye 26, 958–966 (2012). https://doi.org/10.1038/eye.2012.72
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DOI: https://doi.org/10.1038/eye.2012.72
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