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Arnaldo F. Bordon, Gabriela P. Pereira; Ranibizumab In The Treatment Of Age-related Macular Degeneration (AMD): The Three Injections Retreatment Study. Invest. Ophthalmol. Vis. Sci. 2011;52(14):115.
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to evaluate the visual acuity and macular thickness changes with the use of ranibizumab in cycles of 3 injections and strict follow-up regimen in patients with wet AMD.
This is a retrospective study of patients with wet AMD treated with ranibizumab. Three consecutive injections were administered 5 weeks apart. Patients were followed every 5 weeks for the first 6 months and then every 10 weeks until the 12th month if they not show recurrence. Baseline evaluation included complete ophthalmological examination, fluorescein angiography (FA), visual acuity (VA) and central macular thickness measurements using the ocular coherence tomography (OCT). Follow-up visits included VA and OCT measurements in every visit. FA was performed at the first follow-up visit and when needed thereafter. Retreatment criteria included persistence or recurrence of choroidal neovascularization activity and/or VA drop of ≥ 2 lines and/or persistence of fluid and/or CMT > 250 µm on OCT . When retreatment was needed, 3 additional injections 5 weeks apart were used. VA and OCT measurements were analyzed at baseline (BL) and at the last follow-up visit (LFU). The duration of the injection-free time was also analyzed.
Thirty eyes of 28 patients were included. Twenty four were female. All were Caucasian. Mean age was 76 years-old (range, 58 - 86). Half was right eyes and half left eyes. Mean follow-up period was 593.6 days (range,110 - 930 days). Mean BL VA was 1.0 logMAR units (range, 0.2 - 2.6) and LFU VA was 0.6 (range, 0.1 - 2.6). OCT central thickness was 330.4µm (range, 136 - 784 µm) at BL and 206.8 µm at LFU (range, 65 - 399 µm). A mean of 8 (range, 3 - 22) injections were needed during follow-up. The mean last injection-free interval was 209 days (range, 0 - 810 days). After loading dose of 3 injections the mean injection-free interval was 127.5 days.
The use of three injections of ranibizumab to retreat eyes with wet AMD recurrence improved visual acuity and decreased central macular thickness in patients with wet AMD, yet reducing the number of injections. To achieve improvement in VA patients needed an average of 8 injections and tended to have a mean injection-free interval of 127 days and after retreating the injection-free interval increased to an average of 209 days. The proposed regimen of treatment showed reasonable VA results and OCT thickness for patients with wet AMD.
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