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David Gaucher, Mehdi Kheliouen, Eliza Tebeanu, Laurent Ballonzoli, Maher Saleh, Tristan Bourcier, Claude Speeg-Schatz; 2 Year Results for Neovascular Age-Related Macular Degeneration Retreatment by Series of Three Intravitreal Injections of Ranibizumab. Invest. Ophthalmol. Vis. Sci. 2012;53(14):870.
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The PrONTO study retreatment protocol is widely used. Nevertheless this protocol is related to logistical problems for both patients and physicians in terms of number of visits and retreatments. These difficulties may explain the differences observed between the PrONTO study results and those of studies using the same protocol in daily practice. The purpose of this study was to analyze the results of a different retreatment regimen with the PrONTO criteria for retreatment but using series of three ranibizumab monthly injections (IVR) for each retreatment.
66 eyes of 62 patients with exudative AMD were followed for a mean period of 27 months (11-48). The mean age of the patients was 79 (65 to 93). All patients received 3 initial IVR and werer retreated with series of three monthly IVR if needed. The criteria for retreatment were: ≥5 ETDRS letters decrease and/or signs of retinal exudation on OCT. Monthly monitoring visits were conducted when no retreament was performed. Each visit included BCVA measurement and OCT examination.
At two years, the mean number of IVR was 5/patient/year and the mean number of follow-up visits was 4/patient/year. Mean VA did not improve during follow-up (53.18 letters versus 54.18, p> 0.05). However, VA stabilized or improved in 65.6% of eyes. An improvement of 15 letters or more was observed in 28.8% of eyes.
This retreatment protocol reduced the number of follow-up visits without increasing the number of annual IVR.No mean gain of vision was observed using this retreatment protocol at 2 years. Similar results were reported by Cohen et al. in a study using single IVR retreatments. However a greater proportion of patients gained 3 lines or more in our study (28.8% vs 8%). The benefit of the 3 IVR retreatment scheme remains uncertain.
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