RANIBIZUMAB IN TREATMENT OF AGE-RELATED MACULAR DEGENERATION CHOROIDAL NEOVASCULARIZATION

Abstract

SUMMARY AND CONCLUSION A ge-related macular degeneration (AMD) is a medical condition that affects the elderly people, and leads to loss of central vision due to damage to the macula. It’s the main cause of vision loss in people aged more than 50 years in developed countries. Worldwide about 30 million people in the year 2010 were affected by the disease. AMD occurs in 2 forms, wet (neovascular) and dry. Whilst both can lead to vision loss, the wet form is often the more deleterious of the two and is responsible for nearly 90% of severe vision loss among elderly people in the developed world. In the neovascular type, CNV originates from the choriocapillaris, with new vessels penetrating through Bruch's membrane and growing into the subretinal pigment epithelium and/or subretinal space. Newly formed vessels typically lack normal structural integrity, making them susceptible to leakage and hemorrhage. Such leakage can cause retinal edema resulting in visual distortion and marked diminution of vision when the macula is involved Vascular endothelial growth factor (VEGF)-A is a key contributory factor in the pathophysiology underlying neovascular AMD. Several studies have shown that the rise in ocular VEGF levels is linked to the initiation of neovascularization, which is the first step in the pathogenesis of neovascular AMD in both humans and animals. Ranibizumab (anti-VEGF), a recombinant humanized monoclonal antibody antigen-binding fragment, has been reported to neutralize all known active forms of VEGF-A and to block vessel permeability and angiogenesis and hence prevent vision loss and improve visual acuity in patients with neovascular AMD. Major trials have proven the beneficial effect of ranibizumab (anti-VEGF) injections in nAMD. The discovery that anti-vascular endothelial growth factor (VEGF) agents injected intravitreally can reverse the anatomic and visual symptoms of neovascular (wet) age-related macular degeneration (AMD) revolutionized the treatment of wet AMD and other neovascular diseases of the retina. In our study we examined 11 eyes of 11 patients with Neovascular AMD from the ophthalmic department, 6 October hospital, Dokki, Giza, after 3 monthly injection of ranibizumab. All patients were subjected to careful history taking, full ophthalmic examination (including visual acuity, slit lamp examination, applanation tonometry and fundus examination) and ophthalmic investigations (FFA and OCT).