PMC4821150_01
Features of neovascular AMD in the patient's left eye at diagnosis. a Left: fundus photograph of the left eye showing subretinal confluent drusen in the macular area. Center-left: fluorescein angiography showing macular hyperfluorescence in the early stages (center-right) that increases in the late stages. Right: indocyanine green angiography showing late hyperfluorescence. b OCT of the left eye showing RPE detachment with intraretinal, subretinal, and sub-RPE fluid.
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F1
The deposits were associated with pigmentary changes in her left eye (fig. 1a, left). Fluorescein angiography showed no significant alterations in the right eye, but in the left eye, there was early macular hyperfluorescence that increased in the last stages of the angiography (fig. 1a, middle). Indocyanine green angiography showed central hyperfluorescence throughout the examination (fig. 1a, right). Optical coherence tomography (OCT) of the right eye demonstrated only subfoveal drusen and some RPE disruption, whereas OCT of the left eye showed a macular central thickness of 237 microm and intraretinal and subretinal fluid associated with shallow RPE detachment and subfoveal deposits and drusen (fig. 1b).
Changes in the macula and VA while treated with intravitreal ranibizumab alone. a December 2008: fundus photography and OCT of the left eye after three doses of intravitreal ranibizumab. OCT showing drusen, but with marked improvement in the previously observed intraretinal, subretinal, and sub-RPE fluid. b February 2009: fundus photography and OCT of the left eye showing subretinal fluid and RPE detachment due to reactivation of CNV. c-f Fundus photography and OCT showing successive reactivations and improvements after the completion of the corresponding treatments in a pro re nata basis of treatment with ranibizumab during 40 months of follow-up. OCT in panels b, d and f showing the recurrences of intraretinal, subretinal, and sub-RPE fluid. OCT in panels a, c and e showing the subsequent improvement after anti-VEGF treatment.
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F2
AMD. After the initial doses of ranibizumab (August-October 2008) in her left eye, the patient experienced clinical improvement with the disappearance of the subretinal fluid (fig. 2), and her BVCA improved to 0.9. However, during the following 40 months, she experienced decompensation of the neovascular AMD (fig. 2b, d, f), requiring rescue with eleven additional injections of ranibizumab (0.5 mg intravitreal) with intervals of 1-6 months.
AMD improvement with subcutaneous adalimumab treatment (March 2012-October 2014). VA, OCT, and clinical findings remained stable without any additional anti-VEGF therapy after starting subcutaneous adalimumab therapy.
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F3
Vision in her left eye maintained a VA of 0.7 from the first month after initiation of therapy with adalimumab, and no neovascular AMD activity was apparent (fig. 3a-c).