J Korean Med Sci.  2013 May;28(5):769-774. 10.3346/jkms.2013.28.5.769.

Current Smoking Is Associated with a Poor Visual Acuity Improvement after Intravitreal Ranibizumab Therapy in Patients with Exudative Age-Related Macular Degeneration

• Lee S
• Song SJ
• Yu HG

• KMID: 1777567
• DOI: http://doi.org/10.3346/jkms.2013.28.5.769

Abstract

In this study, the risk factors that may influence visual improvement after intravitreal ranibizumab (IVR) treatment for exudative age-related macular degeneration (AMD) were examined. From 2008 to 2012, 420 patients (448 eyes) with exudative AMD were prospectively registered at Seoul National University Hospital. From this group of patients, 125 eyes were included in this study. All patients were treated with 3 consecutive IVR injections. The visual acuity (VA) was evaluated at baseline and 1 month after the third ranibizumab injection. To evaluate the risk factors associated with VA improvement after IVR, patient demographic data and systemic risk factors were analyzed. Patients were divided into a poor VA improvement group and a good VA improvement group, with reference to the median visual improvement in all eyes. Among 125 eyes, 66 eyes (52.8%) were included in the responder group and 59 eyes (47.2%) in the non-responder group. The median VA improvement after 3 monthly ranibizumab injections was -0.05 logMAR. Multivariate analyses revealed that current smoking (adjusted OR, 7.540; 95% CI, 1.732-32.823) was independently associated with poor VA improvement after IVR treatment for exudative AMD. In conclusion, cigarette smoking is an independent risk factor for lower VA gains with IVR treatment for exudative AMD.

Keyword

Exudative Age-Related Macular Degeneration; Ranibizumab; Cigarette Smoking

MeSH Terms

Aged
Antibodies, Monoclonal, Humanized/*therapeutic use
Female
Humans
Intravitreal Injections
Macular Degeneration/*drug therapy/radiography
Male
Middle Aged
Multivariate Analysis
Odds Ratio
Prospective Studies
Risk Factors
*Smoking
Tomography, Optical Coherence
Visual Acuity/*physiology
Antibodies, Monoclonal, Humanized

Figure

• 

  Fig. 1 Fundus photographs and optical coherence tomography (OCT) images from a 57-yr-old male smoker. (A) A baseline fundus photograph shows submacular hemorrhage and exudate. (B) A post-treatment fundus photograph shows persistent submacular hemorrhage, extensive macular retinal pigment epithelial atrophy, and a disciform scar. Pre- (C) and post-treatment (D) OCT images show virtually no anatomical improvements following intravitreal ranibizumab treatment.

• 

  Fig. 2 Fundus photographs and optical coherence tomography images (OCT) of a 73-yr-old male ex-smoker. (A) A baseline fundus photograph shows submacular hemorrhage, the choroidal neovascular membrane, and exudate. (B) A post-treatment fundus photograph shows resolution of the submacular hemorrhage, but choroidal neovascularization and exudate persists. (C) A baseline OCT image reveals subretinal fluid and a thickened choroidal neovascular membrane. (D) A post-treatment OCT image shows resolution of the previously observed subretinal fluid and thinning of a now inactive choroidal neovascular membrane.

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