The Effect of Ranibizumab on Eye Lens Opacity in Cases With Age-Related Macular Degeneration
Condition: Age-Related Macular Degeneration; Cataract
MeSH terms: Cataract; Macular Degeneration
Study type: Observational

Summary: 
      Purpose To evaluate the cataractogenic effect of intravitreal ranibizumab with the use of
      Lens Opacity Classification System III (LOCS III).

      Settings Cases with a diagnosis of wet AMD were included in this university practice based
      prospective study.

      Methods All cases had monthly injections of intravitreal ranibizumab in the first 3 months;
      subsequently an OCT-guided pro re nata injection regimen has been adopted. All cases had a
      comprehensive eye examination and LOCS III evaluation at baseline and 1, 3, 6 and 12 months
      after the initial injection. Examination outcomes and change from baseline in LOCS III grades
      at 12 months were recorded.

      Results Eighteen eyes of 13 cases (7 female, 6 male) were included in this study. The mean
      age at the baseline was 75,3 + 6,6 years. A mean of 3,4 + 0,7 injections were given on each
      eye. Mean follow-up was 13,83 + 2,33 months. Baseline mean visual acuity improved from 1,04 +
      0,10 logMAR units to 0,76 + 0,26 logMAR units after 3 injections (P < 0.05). At the 12th
      month of follow-up mean visual acuity was 0,71 + 0,27 logMAR units. According to LOCS III
      grades none of the cases had a prominent change in nuclear color, nuclear opalescence,
      cortical and posterior subcapsular opacification throughout the follow-up. IOP remained
      stable at all follow-up points. No complications were recorded throughout the study.

      Conclusion Intravitreal ranibizumab is an efficient treatment in wet AMD. Results of LOCS III
      assessments in this pilot study suggest that intravitreal ranibizumab has no effect on the
      progression of lens opacity.
    

Detailed description: 
      In the last decade, significant progress has been made in the treatment of wet AMD. At the
      present intravitreal anti-VEGF therapy has become the mainstay of treatment. Nevertheless,
      intravitreal application is a hazardous procedure with a wide range of complications.
      Endophthalmitis, intraocular pressure (IOP) elevation, retinal detachment, vitreous
      hemorrhage, and cataract are among the major complications.

      The current study is focused on the cataractogenic potential of intravitreal ranibizumab.
      Cataract formation following intravitreal application is frequently associated with an
      inadvertent trauma at the procedure. However, occasionally the drug -itself- may precipitate
      cataract formation. Accelerated formation of cataract, has previously been shown as a
      possible cause of decreased visual acuity, in some cases who received intravitreal injections
      of triamcinolone. However, no prospective study has, as yet, assessed anti-VEGF agent related
      cataract progression in cases of AMD. Herein, the investigators have investigated the
      cataractogenic effect of intravitreal ranibizumab by using the Lens Opacity Classification
      System III (LOCS III).
    

Observational model: Case-Crossover
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Neovascular age-related macular degeneration cases undergoing ranibizumab treatment
      
Keywords: Cataract; Intravitreal; Ranibizumab; LOCS III