Fixation stability measurements in patients with neovascular age-related macular degeneration treated with ranibizumab

Objective: To evaluate which of 2 measuring units (bivariate contour ellipse area [BCEA] vs Fujii) yields more accurate measurements of fixation stability, obtained using the MP-1 device, in patients with neovascular age-related macular degeneration (nAMD) treated with intravitreal injections of ranibizumab, during a 12-month follow-up period. Design: Small retrospective, noncomparative, interventional case series. Participants: A total of 25 eyes in 25 patients (13 males, 12 females; mean age 71.72 +/- 7.98 years). Methods: All participants were older than 50 years, diagnosed with active subfoveal choroidal neovascularization, had best corrected visual acuity (BCVA) values above 20/100, and all lesion types were included. All patients underwent a loading phase with 3 consecutive intravitreal injections of 0.05 mg ranibizumab at monthly intervals. Patients were retreated after the third injection if they exhibited a 100-mu m increase in macular thickness or evidence of intraretinal and/or subretinal fluid and new subretinal hemorrhage, observed with spectral-domain optical coherence tomography and fluorescein angiography. The data collected included BCVA and mean macular sensitivities, BCEA, and fixation patterns, performed at baseline and at months 4 and 12, using the MP-1 device. Results: The mean total injection number was 5.92 +/- 1.18 (minimum 3, maximum 8). Mean BCVA at baseline was 0.55 +/- 0.28 logMAR and increased significantly to 0.50 +/- 0.33 logMAR. Mean macular sensitivity at baseline was 7.06 +/- 4.59 dB and increased significantly to 8.40 +/- 4.82. Mean BCEA was 2.19 +/- 1.38 deg(2) and decreased significantly to 1.68 +/- 1.43 deg(2). Fixation stability patterns, according to the protocol set out by Fujii, did not change significantly during follow-up. Conclusions: Compared with Fujii fixation stability patterns, BCEA correlated better with variations in macular sensitivity and BCVA. BCEA can be added to the traditional parameters used to evaluate the efficacy of intravitreal injections in patients with nAMD.