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Gas-mediated vitreomacular adhesion release with intravitral ranibizumab injections for exudative age-related macular degeneration

Abstract

Purpose

To evaluate the efficiency of gas-assisted vitreomacular adhesion (VMA) release combined with intravitreal ranibizumab injections for exudative age-related macular degeneration (AMD) patients.

Materials and methods

This prospective, interventional case series included a total of 23 eyes of 22 patients. The eyes were treated with intravitreal injection of 0.3 mL of perfluoropropane (C3F8) gas and concomitant intravitreal ranibizumab injection to stimulate VMA release. After three initial loading injections, additional intravitreal ranibizumab injections were performed pro re nata. Over a 12-month period, monthly examinations were performed for best-corrected visual acuity (BCVA, logMAR; logarithm of the minimum angle resolution), optical coherence tomography, and dilated fundus examinations.

Results

After gas injection, 22 eyes (95.7 %) showed complete VMA release at 1 week. Complete VMA was achieved in all eyes at 2 months after VMA release, without serious ocular adverse events except one patient who developed a retinal tear. Mean BCVA was 0.61 ± 0.37 logMAR (20/81 Snellen equivalents) at baseline and 0.46 ± 0.30 logMAR (20/57 Snellen equivalents) at 12 months (P = 0.135). Mean central macular thickness was 357.9 ± 128.6 μm at baseline and 245.6 ± 60.0 μm at 12 months (P = 0.188). Mean numbers of intravitreal ranibizumab injections were 4.8 ± 2.4 times during 12 months (4 to 8 injections).

Conclusion

Gas-assisted VMA release can be used as an efficient alternative for exudative AMD patients with obvious VMA.

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Acknowledgments

The abstract of this study was partially presented as a poster in the 32nd Annual Meeting of American Society of Retinal Specialists, August, 2014, San Diego, CA, USA, and the full data was presented in the 38th Annual Meeting of the Macular Society, February, 2015, Scottsdale, Arizona, USA

Contributions of authors

Design and conduct of study (HM Kang, HJ Koh); collection of data (HM Kang, SJ Lee, CG Kim, EJ Chung, and HJ Koh); management, analysis, and interpretation of data (HM Kang, HJ Koh); and preparation, review, and approval of the manuscript (HM Kang, HJ Koh).

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Corresponding author

Correspondence to Hyoung Jun Koh.

Ethics declarations

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Funding/support

Novartis Korea provided financial support in the form of $59,000 (USD). The sponsor had no role in the design or conduct of this study.

Conflict of interest

HJ Koh is a consultant/advisor for Allergan, Bayer, and Novartis Korea. HJ Koh has received honoraria as a lecturer from Allergan, Bayer, and Novartis Korea. The other authors (HM Kang, SJ Lee, CG Kim, and EJ Chung) certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

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Kang, H.M., Lee, S.J., Kim, C.G. et al. Gas-mediated vitreomacular adhesion release with intravitral ranibizumab injections for exudative age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol 254, 1681–1692 (2016). https://doi.org/10.1007/s00417-015-3257-y

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  • DOI: https://doi.org/10.1007/s00417-015-3257-y

Keywords

  • Age-related macular degeneration
  • Perfluoropropane
  • Posterior vitreous detachment
  • Vitreomacular adhesion
  • Vitreomacular traction