No functional vision improvement after intravitreal ranibizumab injections (IVT) for retrofoveolarchoroidal neovascular age‐related macular degeneration, why?

Purpose To analyse the reasons of no improved functional vision in retrofoveolar choroidal neovascular AMD treated with ranibizumab IVT. Methods 95 eyes of 80 patients,21 men,59 women,with retrofoveolar choroidal neovascular AMD treated by ranibizamab IVT.57 were inaugural cases ,38 previously treated by phototherapy and/or pegaptanib IVT.Patients received intravitreal ranibizumab injection,3 times,every 4 weeks in an inductive treatment,the next injections depending on the follow‐up results.First and 2 months’ interval follow‐up exam included ETDRS visual acuity (VA),complete ophthalmic examination,fundus autofluorescence(FAF),fluorescein (FA) and infracyanine (ICG) angiography,and time and/or spectral domain optical coherence tomography (OCT).VA and OCT were done before each IVT.FAF,OCT,FA and ICG analysis appreciate photoreceptor(PR),pigment epithelium(PE) layers,atrophic areas,neovascular net’s leakage and flow. Results Atrophic areas increased 20%,above all in predominant atrophic areas AMD, photoreceptor layer decreased in depth in 30%,pigment epithelium was 25% less dense in 42%,exudative reaction was 30% still present in 58%,neovascular net’s flow and leakage was 45% left in 60%.Initial intense exudative neovascular AMD, most atrophic PE areas AMD,choroido‐retinal anastomosis with neovascular AMD were predominantly concerned.Results are nevertheless better than PDT alone,than pegaptanib IVT on exudative reaction but obviously no,on PR and PE trophicity.AMD and/or ranibizumab IVT involvement is discussed. Conclusion To consider all those notions is essential to choose the best therapeutic strategy, the most appropriate selective or no anti‐VEGF, to go on in the understanding of AMD.