Retinal Pigment Epithelial Atrophy in Neovascular Age-Related Macular Degeneration After Ranibizumab Treatment

Am J Ophthalmol. 2016 Jan:161:94-103.e1. doi: 10.1016/j.ajo.2015.09.032. Epub 2015 Oct 1.


Purpose: To investigate the risk factors for development and progression of retinal pigment epithelial (RPE) atrophy during ranibizumab treatment for neovascular age-related macular degeneration (AMD) in Japanese patients.

Design: Retrospective interventional case series.

Methods: This study included 195 eyes with treatment-naïve subfoveal neovascular AMD. All patients were treated with an as-needed regimen after 3 monthly ranibizumab treatments. Color fundus photography, spectral-domain optical coherence tomography, and fundus autofluorescence were evaluated for RPE atrophy diagnosis. Baseline characteristics and ARMS2 A69S and CFH I62V polymorphisms were analyzed for their association with development and progression of RPE atrophy.

Results: Ten of 195 eyes (5.1%) had RPE atrophy at baseline; 3 had typical AMD and 7 had polypoidal choroidal vasculopathy (PCV). Among 185 eyes without preexisting RPE atrophy at baseline, 7 (3.8%) developed RPE atrophy at 12 months and 10 (5.4%) during the mean follow-up of 26.7 months. The incidence of newly developed RPE atrophy was lower in PCV than in typical AMD (P = .036), while the progression of the RPE atrophy area was faster in typical AMD than in PCV (0.57 ± 0.35 and 0.31 ± 0.13 mm/year, respectively; P = .018). The ARMS2 A69S and CFH I62V polymorphisms were significantly associated with the baseline RPE atrophy (P = .014 and P = .009, respectively).

Conclusions: The RPE atrophy developed in 5.4% of eyes with neovascular AMD during the 26.7 months of ranibizumab treatment. When compared with white individuals, RPE atrophy developed less frequently in Japanese patients, but the progression rate was similar. The subtype of AMD thus affects the development of RPE atrophy.

Publication types

  • Clinical Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Angiogenesis Inhibitors / therapeutic use*
  • Atrophy
  • Complement Factor H / genetics
  • Disease Progression
  • Female
  • Fluorescein Angiography
  • Genotyping Techniques
  • Humans
  • Intravitreal Injections
  • Male
  • Polymorphism, Single Nucleotide
  • Prevalence
  • Proteins / genetics
  • Ranibizumab / therapeutic use*
  • Retinal Diseases / diagnosis*
  • Retinal Diseases / epidemiology
  • Retinal Pigment Epithelium / pathology*
  • Retrospective Studies
  • Risk Factors
  • Tomography, Optical Coherence
  • Vascular Endothelial Growth Factor A / antagonists & inhibitors
  • Wet Macular Degeneration / drug therapy*


  • ARMS2 protein, human
  • Angiogenesis Inhibitors
  • CFH protein, human
  • Proteins
  • VEGFA protein, human
  • Vascular Endothelial Growth Factor A
  • Complement Factor H
  • Ranibizumab