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Christophe Morel, Gipsy Lefebvre, Laure Chevalier, François Devin, Bruno Morin; Evolution of visual acuity in Patient with Wet AMD treated With Ranibizumab in real Life Condition of use. Invest. Ophthalmol. Vis. Sci. 2012;53(14):2915.
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To describe the evolution of visual acuity and the social impact in patients with wet age-related macular degeneration (wAMD) treated with ranibizumab in current practice in a vitreo retinal centre.
Cohort study sponsored by Novartis. 152 patients who had OCT during October 2010 for wAMD and who were treated by ranibizumab for 12 months or more were retrospectively studied. Functional results at 12 months and in October 2010, financial and social impact were studied. The influence of an induction phase (three monthly injections), the influence of strict monitoring (9 or more visits during the first 12 months) and the influence of an exclusive follow up in the vitreo retinal centre were evaluated.
The mean age was 77, 92 at the first injection. The visual acuity (VA), measured by EDTRS, was 56,5 +/-17,01 letters initially, 58,1+/- 19,8 at 12 months and 56,7+/-21,6 in October 2010 with a 24,6 +/-8,6 months follow up. At 12 months the average number of visits were 6,9 +/- 2,1 for an average of 4,9 +/-2 injections. 28% of patients gained 10 or more letters and 43 % read 70 or more letters, 21 % lost 10 or more letters. 77 patients had an induction phase, 34 patients were strictly monitored and 85 had an exclusive follow up in the vitreo retinal centre. None of these features were associated with a different outcome. In October 2010, the average number of visits was 13,7 +/-6,1 for an average of 8,1 +/- 4,7 injections. The main complaints were long waiting time before consultation (40%), cost of regular consultations and transport (30%), stress due to injection and unknown prognosis. Only one patient regretted being involved in this therapy despite those discomforts.
A moderate visual gain was observed at 12 months under treatment, in real conditions of exercise. But VA seems slowly reduced with a longer follow up. These results are lower than those of prospective studies. It can be explained by the difficulty to obtain strict monthly monitoring in older patients with time or by the progression of the underlying disease. This cohort study will be followed during the next 2 years.
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