Resolution of retinal pigment epithelial detachment associated with exudative age‐related macular degeneration following intravitreal ranibizumab therapy

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Editor, A retinal pigment epithelial detachment (PED) is often associated with choroidal neovascularization (CNV) in patients with exudative age-related macular degeneration (EAMD) (Zayit-Soudry et al. 2007). The best treatment for PED associated with CNV in AMD is unclear (Poliner et al. 1986). Intravitreal injection of the antivascular endothelial growth factor ranibizumab (Lucentis®; Genentech, Inc., South San Franciso, California, USA) has been shown to be effective in stabilizing and improving visual acuity in patients with EAMD (Rosenfeld et al. 2006). We report a patient with bilateral EAMD with PED in whom intravitreal ranibizumab resulted in resolution of the PEDs. An 83-year-old woman, with a history of bilateral occult CNV associated with PED unresponsive to six intravitreal injections of pegaptanib (Macugen®; OSI) in the right eye and one intravitreal injection of pegaptanib in the left eye, presented with persistent blurred vision in both eyes. On examination, best-corrected Snellen visual acuity was 0.33 in each eye. Dilated fundus examination showed bilateral PEDs with subretinal fluid confirmed by optical coherence tomography (OCT) (Carl Zeiss Meditec, Dublin, CA, USA) (Fig.1). The patient was treated with two intravitreal injections of ranibizumab (separated by 1 month) in the right eye and three intravitreal injections of ranibizumab (given 1 month apart) in the left eye. Three months after the first injection in each eye, visual acuity improved to 0.5 in each eye and the PEDs were resolved (Fig.2). At 1 year of follow-up, the patient has received a total of five intravitreal injections of ranibizumab in the right eye and six injections in the left eye; visual acuity has remained at 0.5 in both eyes without recurrence of the PEDs. Optical coherence tomography (OCT) before ranibizumab treatment. (A) Right eye. (B) Left eye. Optical coherence tomography (OCT) after ranibizumab treatment showing resolution of retinal pigment epithelial detachments. (A) Right eye (B) Left eye. Photodynamic therapy, intravitreal tramcinolone acetonide and intravitreal pegaptanib sodium have been shown to be ineffective in resolving PEDs (Axer-Siegel et al. 2006). A recent report on the use of intravitreal bevacizumab for refractory PEDs with occult CNV showed improvement in visual acuity without resolution of the PED (Chen et al. 2007). The patient reported herein demonstrates improvement of visual acuity and resolution of refractory PEDs after a series of intravitreal injections of ranibizumab. The use of ranibizumab for the treatment of PED associated with CNV in EAMD warrants further investigation.

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