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Anchal Kailey, Manju Chandran, Fani Zacharaki, Maheswari Chekuri, Geeta Menon; Four year results of visual outcome in Neovascular Age Related Macular Degeneration (AMD) treated with Ranibizumab. Invest. Ophthalmol. Vis. Sci. 2013;54(15):3826.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate four year treatment results of visual outcome in patients with neovascular AMD treated with Ranibizumab and compare with landmark trials.
Retrospective data analysis of patients who first attended the AMD clinic between 2007 and 2008 with diagnosis of neovascular AMD and were treated with intravitreal Ranibizumab. Treatment involved 3 loading doses of Ranibizumab followed by strict four week review and retreatment on per re nata (PRN) basis. Data analysis included demographics, Best Corrected Visual Acuity (BCVA) and mean number of injections.
A total of 143 treatment-naïve patients first attended our AMD clinic between 2007- 2008. Discontinuation rate was 21.7% (31 patients) compared with 22% in multi centre trials. Eleven patients were deceased, 10 missed follow-up due to change of residence location, and the remaining 10 for other reasons. 112 patients who completed 48 months follow-up were included in the analysis. Mean age was 83.54 years (SD 7.77). Mean BCVA at baseline was 47.72 ETDRS letters (SD 16.03). At 12 months, mean BCVA was 55.79 (SD 17.79) showing an improvement of 8.07 letters (P=0.01). Mean number of injections for this period was 5.78. This visual outcome was maintained at 24 months with a gain 9.5 letters (p=0.01) with a mean number of injections of 2.8. Similarly, at 36 months, mean BCVA was 55.83 (SD 19.9) and a gain of 8.11 letters was achieved. Mean number of injections for the third year was 2.47. Finally, at 48 months, our patients maintained a gain of 6.24 letters receiving a mean of 2.89 injections. 8.9% of patients (n=10) lost more than 15 ETDRS letters, compared to 91.1% who maintained vision, a result consistent with the large multi centre trials. 13.94 was the cumulative mean number of injections over the four year period.
Our study shows that with strict four weekly follow-up and prompt retreatment within a PRN scheme, good visual outcome can be achieved and maintained for a period as long as four years. The need for retreatment seems to decrease significantly after the first 12 months.
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