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Wolfgang F. Schrader, Eva Hoessler, Roman Regler, Otmar Ringhofer, Adrian Bernhard; The Number Of Intravitreal Injections (ivi) Needed Beyond 2 Years Of Treatment For Wet Amd With Ranibizumab Or Bevacizumab Cannot Be Predicted By The Injection Frequency In The 1st Year Of Treatment. Invest. Ophthalmol. Vis. Sci. 2012;53(14):2030.
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MARINA, ANCHOR and HORIZON studies showed that visual acuity (VA) can be preserved by 4-weekly intravitreal injections (IVI) of ranibizumab over >2 years (yrs).In the CATT-trial ranibizumab and bevacizumab have comparable results on a monthly IVI treatment (TX) as well as on a PRN (pro re nata) TX. In Germany, most insurance companies allowed a re-TX of active lesions only after at least 5 letters loss of visual acuity (VA) following the previous TX-course. However, a PRN-TX based on VA changes rather than OCT changes has less favourable results. The aim of this study is to investigate whether the IVI rate in the 1st yr can predict the IVI rate in the following years and whether a low IVI rate in the 1st yr is related to the same VA changes after 3yr as a higher IVI rate.
Retrospective analysis of 88 patients with wet AMD, initially treated with either 3 IVI of bevacizumab (1.5mg) or ranibizumab (0.5mg), followed by PRN-IVI. Main outcome parameters were the VA change after a follow up (FU) of >3 yrs, the total number of IVI needed and the frequency of IVI in the 1st, 2nd and 3rd yr of TX.
88 eyes (88 patients, mean age 77.1 yrs, 55 females, 33 males) had a FU of >3yrs. Mean FU time was 3.75yrs. 11.1±5.7 IVI were performed. Mean no. of IVIs in the 1st yr was 4.66±1.52 (range 3-8), in the 2nd year 2.7±2.1 (range 0-8) and in the 2rd yr 2.7±2.4 (range 0-10). Comparing the group of patients with less than 5 IVI in the 1st year to those with >4 IVI, the no. of IVIs needed in the 2nd and 3rd yr could not be predicted from the IVI frequency in the 1st yr of TX. VA slightly decreased from 0.63 logMAR at baseline to 0.77 logMAR after 3 yrs of TX. This decrease was (not significantly) higher, when 4 or less IVI were applied in the first yr (from 0.61 to 0.86 logMAR) as compared to >4 IVIs (from 0.64 to 0.68 logMAR). Patients with initial VA of >0.3 received more IVI in the 3rd yr (3.3 IVIs in 3rd yr and 3.2 beyond 3rd yr) than those with an initial VA of less than 0.3 (1.9 and 0.9 IVI resp.).
A low IVI rate over 3 yrs as well as a low IVI rate in the first yr was not related to a singificantly higher deterioration of visual acuity. Patients with wet AMD need close FU and frequent IVI even beyond two yrs after initiation of TX, especially those with a baseline VA of >0.3.
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