Indications

Currently, intravitreal ranibizumab (Lucentis) injection (with or without associated verteporfin photodynamic therapy (PDT)) has provided the best visual results reported for treatment of subfoveal choroidal new vessels (CNVs) in patients with age-related macular degeneration (AMD). (Nonrandomized case series also indicate a benefit for treatment of myopia-associated CNVs and AMD using bevacizumab [Avastin].) Intravitreal ranibizumab has been proved to be effective in randomized clinical trials (including active controls with randomization to verteporfin PDT for patients with predominantly classic CNVs) regardless of lesion type (classic, occult, mixed), and presenting visual acuity. Overall, 90–95% patients experience less than 15 letters visual loss on the Bailey-Lovie visual acuity chart and 25–40% of patients experience moderate visual improvement when patients receive monthly intravitreal injections during the course of 1 year.

Preoperative Procedure

Complete retinal examination including stereoscopic contact lens examination of the macula. Fluorescein angiography and optical coherence tomography are done to document (or diagnose) presence of subfoveal CNV as well as amount of subretinal fluid present.

Instrumentation

Sterile gloves

Sterile lid speculum

2 Betadine swabs

Topical proparacaine (fresh bottle)

Lidocaine 1% without epinephrine (optional)