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Wolf, Armin MD*; Rüping, Johann MD*; Neubauer, Aljoscha S. MD*; Mayer, Wolfgang MD*; Ulbig, Michael MD*; Haritoglou, Christos MD*; Holz, Frank G. MD; Eter, Nicole MD; Kampik, Anselm MD*

doi: 10.1097/IAE.0b013e318287d9be
Original Study

Purpose: To describe morphologic alterations of pigment epithelial detachments (PEDs) associated with neovascular age-related macular degeneration during anti–vascular endothelial growth factor upload therapy with ranibizumab.

Methods: Prospective, single-arm interventional study. Primary outcome was the reduction of height of PED during monthly treatment using ranibizumab. Secondary outcomes were factors influencing the regression of PED. Inclusion criteria were presence of PED associated with naive neovascular age-related macular degeneration, visual acuity of >20/200, and height of PED >150 μm on optical coherence tomography. All eyes (n = 54) received 3 injections of ranibizumab in monthly intervals (“upload therapy”). Last review examination was performed 14 weeks after the initial treatment.

Results: The mean PED height decreased from 515 μm (SD, 268.3) to 294 μm (SD, 201.9) at Week 14 with the highest degree of regression after the first treatment. A complete resolution of PED was noted in 8 eyes (15%). Using conventional regression model, none of the factors investigated, including height of PED, presence of intraretinal or subretinal fluid, intraretinal cysts, macular volume, retinal thickness, presence of foveal depression, presence of hemorrhage, and visual acuity, had a significant impact on the morphologic response. Using a modified binary logistic regression model (“bootstrapping”), presence of foveal depression (P > 0.033), and retinal thickness (P > 0.004) showed statistical significance.

Conclusion: This study on the responses and potential predictive factors associated with vascularized PED during the uploading phase of intravitreal ranibizumab shows a complete resolution of the PED in 15% of the cases.

The paper investigates the response rate of pigment epithelial detachment during an "upload" therapy of anti–vascular endothelial growth factor treatment (ranibizumab) and seeks to determine predictive factors for pigment epithelial detachment response. Although documenting a good response rate of 15%, certain factors on optical coherence tomography examination could be identified to possible predict response of pigment epithelial detachment during anti–vascular endothelial growth factor treatment.

*Department of Ophthalmology, Klinikum der Universität München, LMU, University Eye Hospital, Munich, Germany;

Department of Ophthalmology, University of Bonn, Bonn, Germany; and

Department of Ophthalmology, University of Muenster, Muenster, Germany.

Reprint requests: Armin Wolf, MD, Department of Ophthalmology, Klinikum der Universität München, LMU Campus Innenstadt, Mathildenstrasse 8, D-80336 Munich, Germany; e-mail:

A. Wolf and J. Rüping contributed equally to this study.

No authors have any financial/conflicting interests to disclose.

© 2013 by Ophthalmic Communications Society, Inc.