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Bobeck S. Modjtahedi, Lawrence S. Morse, Saadia Rashid, Susanna Park; Response To Double Dose Ranibizumab Among Eyes With Exudative Age-related Macular Degeneration Resistant To Regular Dose Anti-VEGF Therapy. Invest. Ophthalmol. Vis. Sci. 2012;53(14):2034.
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To examine the response to double dose ranibizumab (DDR) (1.0 mg) in cases of exudative age related macular degeneration (eAMD) refractory to standard dose anti-VEGF therapy.
Retrospective chart review of patients treated with DDR for eAMD after standard dose anti-VEGF treatment from October 2010 until November 2011. Patients with a history of other retinal pathology or prior treatment with either photodynamic therapy or steroid injections within the past 6 months were excluded. Optical coherence tomography (OCT) and best corrected visual acuity (BCVA) before and after DDR were reviewed. Institutional review board approval was attained.
8 patients (10 eyes) met inclusion criteria. All patients were primarily treated with ranibizumab, with only one eye briefly treated with bevacizumab between ranibizumab injections. Average vision at baseline was approximately 20/100. Subjects received an average of 19 +/- 12 standard dose anti-VEGF treatments (range 9-36) prior to DDR. Indication for initiating DDR was persistent macular fluid on OCT on regular dose anti-VEGF therapy. All subjects received at least two injection of DDR (average 4.7, range 2-10). Baseline average central macular thickness (CMT) was 313 +/- 76 µm; 7 eyes had sub-retinal fluid (SRF), 9 eyes had pigment epithelial detachments (PED), and 5 eyes had macular edema (ME). Seven of 10 eyes had some improvement anatomically on OCT (SRF size, PED size, and/or degree of ME) following DDR treatment, 4 eyes had improvement noted after the first dose of DDT. After the first injection there was a decrease in average CMT of 33.6 µm (n=10, average CMT 280+/-76 µm, p=0.07), followed by a decrease of 64.5 µm compared to baseline after second injection (n=10, average CMT 248.6+/-50.1 µm, p=0.04), and after the third injection a decrease in 30.6 µm from baseline (n=7, average CMT 299.1+/-66.0 µm, p=0.39). None of the seven eyes treated with more than two injections of DDR demonstrated new changes after the second dose. Two eyes demonstrated gain of 2 lines or better of visual acuity during the study while a loss of 2 lines or more was seen in one eye. There were no RPE tears or systemic vascular events noted.
Eyes with exudative AMD with macular fluid resistant to regular dose anti-VEGF therapy may respond to double dose ranibizumab.
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