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Masako Kuroda, Hiroshi Kojima, Takanori Kameda, Michiko Mandai, Noriko Miyamoto, Akihiro Nishida, Yasuo Kurimoto; Response and dependence to ranibizumab therapy in AMD. Invest. Ophthalmol. Vis. Sci. 2013;54(15):3805.
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Immediate practice of as-needed injection of ranibizumab is still a burden to some patients or facility. To estimate a situation of therapy requirement, we aim to evaluate the response and dependency to ranibizumab injection therapy and related factors in neovascular age-related macular degeneration (AMD).
Medical records of 81 treatment-naïve AMD eyes of 80 Japanese patients who received initial three monthly intravitreal ranibizumab induction therapy in our clinic from Jun 2009 to Dec 2011 were reviewed. One month after completion of induction therapy, all eyes were evaluated and classified into two groups: well responded group if they did not need additional ranibizumab injection according to the PrONTO study protocol (AJO2009:148; 43-58), and insufficiently-responded group if they did. If the exudative change in OCT worsened within three months after completion of induction therapy, the eye was defined as treatment dependent. We thereby defined each subgroup as follows: group A; well-responded and non-dependent, group B; well-responded but dependent, group C; insufficiently-responded and non-dependent, and group D; insufficiently-responded and dependent.
Forty-eight eyes (59%) well responded to the induction therapy whereas 33 eyes (41%) had insufficient response. The eyes in insufficiently-responded group had had a higher rate of cystoid macular edema (CME) (P < 0.01) and larger great linear dimension (GLD) (P < 0.05) before induction therapy. They did not show a significant improvement in visual acuity after induction therapy. Twenty-three eyes were categorized as group A, 25 as B, 15 as C and 18 as D. Eyes in group A needed less additional injections than those in group B, and showed a better visual outcome. Eyes in group D needed more injections than those in group C.
Of all treatment-naïve AMD patients, 59% well-responded to ranibizumab induction therapy. Half of these eyes were ranibizumab-dependent requiring repeated injections and showed poorer visual outcome. Insufficiently-responded eyes with CME or large GLD may require continuous re-injections or a combined therapy such as with photodynamic therapy.
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