Authors : Dr. Inturi Jyostna; Dr. M. Parni Kumar

Volume/Issue : Volume 9 - 2024, Issue 2 - February

Google Scholar : http://tinyurl.com/4ed28zu4

Scribd : http://tinyurl.com/yjmmhuyx

DOI : https://doi.org/10.5281/zenodo.10725862

Abstract : Introduction: Angiogenesis is a physiological process in which pre existing vessels develop into new ones. The earliest type of angiogenesis to be discovered was sprouting angiogenesis. It goes through a number of distinct stages. First, endothelial cells in veins that already exist have their receptors activated by angiogenic growth factors. Then the release of proteases enzymes is initiated by activated endothelial cells, to break down the basement membrane, enabling the endothelial cells to move away from the original vessel walls. Thereafter, the endothelial cells multiply inside surrounding matrix and create sturdy shoots that join nearby vessels. Using Adhesion molecules called integrins, endothelial cells migrate in synchrony with sprouts as they extend toward source of angiogenic stimulus. As cells move to the site of angiogenesis, these sprouts eventually develop into loops that eventually produce a fully developed vessel lumen. Sprouting allows new vessels to develop over gaps in vasculature and happens at a rate of several millimeters each day. But unlike splitting angiogenesis, it generates whole new vessels instead of splitting old ones, which makes a significant difference. VEGF, also known as Vascular Endothelial Growth Factor, has been proven to play significant role in angiogenesis. Elevated levels of VEGF-A are found in vitreous fluid of patients with diabetic retinopathy, wet age related macular degeneration, macular edema due to venous occlusions.  Aim of the Study: To assess the safety and effectiveness of intra vitreal Ranibizumab in treating different retinal vascular disorders.  Patients and Methodology: This is prospective study, done at Department of Ophthalmology, Katuri Medical College and Hospital from September 2022 to August 2023, spanning a period of 1 year. This study included patients with proliferative diabetic retinopathy, central retinal vein occlusion, branch retinal vein occlusion, Wet age related macular degeneration. This study excluded existence of any retinal disorders that could impact visual acuity and the development of significant cataracts. Comprehensive medical and ocular history was obtained on the initial visit. All patients received comprehensive ophthalmic examinations. 1. Best corrected visual acuity for distance and near vision. 2. Intraocular pressure measurement. 3. Ophthalmic examination with a slit lamp 4. Fundoscopy 5. Fundus photography 6. Fundus fluorescein angiography 7. Macular thickness assessment using Optical Coherence Tomography.50 eyes from 50 patients were examined. Follow-up was conducted at 3 days, 2 weeks, 1 month, and then monthly for 6 months.  Results: The majority of patients are within age range of 51- 60 years. Among 50 responders, 29 were female and 21 were male. 50 patients have received an injection ranibizumab in one eye. There were 33 cases of diabetic retinopathy, 3 cases of branch retinal vein occlusion, 3 cases of central retinal vein occlusion, and 11 cases of age-related macular degeneration.50 eyes were administered 0.5mg of Ranibizumab (Lucentis) in 0.05ml. Visual acuity improved in 40 eyes (80%) and remained unchanged in 10 eyes (20%).Visual acuity significantly improved one month after injection and continued to improve in all subsequent follow-up visits.A statistically significant association was found between periodic injections and increase in visual acuity. Thirty-three patients exhibited PDR. 27 eyes showed improvement, while 6 eyes remained unchanged. BRVO was observed in three cases. Two eyes showed improvement, while one eye remained unchanged. CRVO was observed in three cases. Two eyes showed improvement, while one eye remained unchanged. Age-related macular degeneration (ARMD) was observed in 11 cases. 9 eyes showed improvement while 2 eyes remained unchanged.  Conclusion: Ranibizumab shows efficacy in treating several retinal vascular disorders. Best corrected visual acuity improvement was statistically significant. Ranibizumab's impact seems to be temporary, requiring further injections if recurrences occur.Complications from the procedure are quite uncommon. Ranibizumab appears to be a safe treatment choice for people who do not respond to traditional laser photocoagulation.

Keywords : Proliferative Diabetic Retinopathy(PDR), Age Related Macular Degeneration(ARMD),Branch Retinal Vein Occlusion(BRVO),Central Retinal Vein Occlusion(CRVO), Ranibizumab (Lucentis).