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Jignesh Patel, Sharon Woollard, Nicola Hopkins, Asad Zaheer, Adil Salim, Giles Baggiony-Taylor, Bhamini Sellathurai, Vivek Bansal; Clinical outcomes of differing loading phase regimes in the management of neovascular age related macular degeneration (nvARMD). Invest. Ophthalmol. Vis. Sci. 2013;54(15):3809.
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© ARVO (1962-2015); The Authors (2016-present)
To assess the visual outcomes and retinal thickness of two different intravitreal ranibizumab loading phase regimes in the treatment of nvARMD
Retrospective review of the clinical parameters (ETDRS Letters, Central Subfield Thickness (CSF) on SD-OCT) of patients managed using two different loading phase regimes of ranibizumab. One regime involved treatment along the definitions of the PRONTO clinical trial (Pronto method, loading phase of three monthly consecutive injections) (n=40 eyes) and the second followed the management of the MARINA / ANCHOR trial (pseudo Marina method) with five loading phase injections and then PRONTO protocol (n=50 eyes).
Baseline characteristics for PRONTO group was mean age 79 years and mean baseline vision of 51 letters compared to the pseudo MARINA group of a mean age 80 and baseline vision 55 letters. At 12 and 24 months there was a mean gain of four and nine letters respectively compared to baseline but at 30 months no gain in vision in the PRONTO group whilst for the pseudo MARINA group mean letters gain was eight (at 12 months), six (at 24 months) and six (at 30 months). The mean CSF for PRONTO was 320 microns at baseline and 225, 203 and 250 microns at 12, 24 and 30 months compared to mean baseline of 321 microns and 244, 206 and 200 microns at 12, 24 and 30 months. The mean number of injections was 6 for the PRONTO group and 8 in the pseudo MARINA group in the first year whilst in the second year only a mean of 3 injections for both groups.
These results would suggest that an initial intensive loading phase in the management of nvARMD can lead to gaining and maintaining vision through to 30 months from baseline compared to standard PRONTO loading phase of three consecutive injections.
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