الفهرس 
Introduction & Aim of the workOnly 14 pages are availabe for public view
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Abstract
Age-related macular degeneration (AMD) is a medical condition that affects the elderly people, and leads to loss of central vision due to damage to the macula. It’s the main cause of vision loss in people aged more than 50 years in developed countries (Chiou.,2011).
AMD occurs in 2 forms, wet (neovascular) and dry. Whilst both can lead to vision loss, the wet form is often the more deleterious of the two and is responsible for nearly 90% of severe vision loss among elderly people in the developed world (Ferris et al.,2013).
In the neovascular type, CNV originates from the choriocapillaris, with new vessels penetrating through Bruch’s membrane and growing into the subretinal pigment epithelium and/or subretinal space. Newly formed vessels typically lack normal structural integrity, making them susceptible to leakage and hemorrhage. Such leakage can cause retinal edema resulting in visual distortion and marked diminution of vision when the macula is involved(Yanoff and Duker.,2014).
Vascular endothelial growth factor (VEGF)-A is a key contributory factor in the pathophysiology underlying neovascular AMD. Several studies have shown that the rise in ocular VEGF levels is linked to the initiation of neovascularization, which is the first step in the pathogenesis of neovascular AMD in both humans and animals (Ishikawa et al.,2005).
Ranibizumab (anti-VEGF), a recombinant humanized monoclonal antibody antigen-binding fragment, has been reported to neutralize all known active forms of VEGF-A and to block vessel permeability and angiogenesis and hence prevent vision loss and improve visual acuity in patients with neovascular AMD (Gaudreault et al.,2005).Major trials have proven the beneficial effect of ranibizumab (anti-VEGF) injections in nAMD(Rosenfeld et al.,2006).
In our study we examined 30 eyes of 30 patients with Neovascular AMD from the ophthalmic department of Fayoum hospital of ophthalmology, Fayoum University hospital, Insurance hospital in Fayoumbefore and after 3 monthly injection of ranibizumab.
All patients were subjected to careful history taking, full ophthalmic examination (including visual acuity, slit lamp examination, applanation tonometry and fundus examination) and ophthalmic investigations (FFA and OCT).
In our study, BCVA (LogMAR) increased from 1.2 ±0.20 SD to 1.03 ±0.33 SD after 3 months of injections which agrees with previous studies like MARINA study , ANCHOR study , PIER study andSUSTAIN study.
On OCT, mean CMT improved from 446 µm to 272.9 µm after 3 monthes of injections which agrees with EXCITE study ,SUSTAIN studyandCATT study.
There is no impact on IOP after intravitreal injection of ranibizumab as all patients had normal IOP before and after the injections.
In conclusion, the results of this study indicate that Intravitreal administration of ranibizumab can prevent vision loss, improve mean visual acuity and restore macular anatomy, with low rates of serious adverse events (AEs), in patients with neovascular AMD.