Long-term effect of intravitreal ranibizumab therapy on retinal nerve fiber layer in eyes with exudative age-related macular degeneration

  • Alicia Valverde-MegíasEmail author
  • Aurora Ruiz-Calvo
  • Antonio Murciano-Cespedosa
  • Samuel Hernández-Ruiz
  • Jose María Martínez-de-la-Casa
  • Julián García-Feijoo



To investigate long-term effect (96 months) of intravitreal ranibizumab administered for exudative age-related macular degeneration (AMD) on retinal nerve fiber layer (RNFL) thickness when used following a pro re nata regimen.


In this prospective study, 20 eyes of 20 patients diagnosed with exudative AMD were included. Contralateral non-exudative AMD eyes of nine of these patients were included as controls. Data on intraocular pressure (IOP) and number of injections were recorded. Spectralis optic coherence tomography (OCT) of the circumpapillary RNFL was performed under dilation when diagnosis was made and before the three loading injections. “Follow-up” software was selected to accurately compare baseline with subsequent images through the 8 years of the study.


Baseline IOP was 14.1 mmHg both in study (standard deviation, SD: 0.8) and control eyes (SD: 0.9) and remained unchanged during the study. Mean number of injections was 21 (SD: 2.8) at the end of the study. Mean average thickness of RNFL in the study eye group at the end of the study was 96.5 μm (SD: 2.1). Mean loss for the study period was 5.3 μm (SD: 0.7; p < 0.0001). Corresponding RNFL values for controls were 92.9 (SD: 3.2) and 5.8 μm (SD: 1.2; p < 0.001). Superior temporal sector had the greatest loss in both groups, followed by inferior and nasal sectors. No statistically significant differences were found when comparing losses in injected eyes versus control eyes.


RNFL thickness decreased both equally in injected eyes and control eyes. Thus, no long-term effects of intravitreal ranibizumab were observed on the retinal nerve fiber layer thickness.


Nerve fiber layer anti-VEGF OCT AMD Ranibizumab 



No funding was received for this research.

Compliance with ethical standards

Conflict of interest

Author Alicia Valverde-Megías declares that she has no conflict of interest. Author Aurora Ruiz-Calvo declares that she has no conflict of interest. Antonio Murciano-Cespedosa declares that he has no conflict of interest. Samuel Hernández-Ruiz declares that he has no conflict of interest. Jose María Martínez-de-la-Casa declares that he has no conflict of interest. Julián García-Feijoo declares that he has no conflict of interest.

No conflicting relationship exists for any author.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

This article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Financial support



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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Alicia Valverde-Megías
    • 1
    • 2
    Email author
  • Aurora Ruiz-Calvo
    • 3
  • Antonio Murciano-Cespedosa
    • 4
  • Samuel Hernández-Ruiz
    • 1
  • Jose María Martínez-de-la-Casa
    • 1
  • Julián García-Feijoo
    • 1
  1. 1.Ophthalmology Unit, Hospital Clínico San CarlosInsituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC)MadridSpain
  2. 2.Ophtalmology DepartmentSan Carlos Clinical HospitalMadridSpain
  3. 3.Sureste Clinical HospitalMadridSpain
  4. 4.Facultad de BiologíaUniversidad Complutense de MadridMadridSpain

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