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Heinrich Gerding, Lars Hefner, Melanie Timmermann; Results Of Flexible Ranibizumab Treatment After Four Years In Age-related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2012;53(14):5170.
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To investigate the efficacy of long-term ranibizumab PRN treatment in patients with wAMD.
Retrospective analysis of an institutional case series (104 patients, 104 eyes, mean age +/- SD: 77.6 +/- 7.3 years). All patients were examined monthly during year 1 and further on as close as possible to a monthly regimen. Re-treatment was allowed for any signs of disease activity. Treatment response was classified according to the 12 months results into 3 categories: winner with >1 line of VA improvement (n=47, 45 %), stabilizer with +/- 1 line VA change compared to baseline (n=34, 33%), and loser with >1 line of VA loss (n=23, 22 %).
83 of 104 patients (80%) completed the 48-month visit. Visual acuity (VA) improved by 1.0 +/- 0.3 (mean +/- SE) lines until month 12, 0.8 +/- 0.3 lines until month 24, 0.6 +/- 0.3 until month 36, and 0.1 +/- 0.4 lines until month 48 (p<0.001, month 12 versus month 48). The average number of injections per year was 5.8 +/- 2.3 (mean +/- standard deviation) in year 1, 3.2 +/- 2.9 in year 2, 2.9 +/- 2.9 in year 3 and 2.7 +/- 2.9 in year 4. Average VA decreased in the winner group between month 12 and month 48 by -1.5 lines (p<0.0005), by -0.24 lines (not significant) in the stabilizer group, and improved in the looser group by +0.65 lines (not significant). Average OCT central foveal point thickness (CFPT) remained stable after the loading phase of 3 injections in the winner group. In the stabilizer and loser groups transient increases of mean CFPT occurred within the first year. From year 2 to 4 CFPT continuously decreased in the loser group due to outer layer degeneration of the retina.
The long-term results in this case series demonstrate that flexible ranibizumab treatment of wAMD results in a long-term visual stabilization clearly superior to the natural course of disease. In year 2-4 significant loss of previous VA gain occurred in the winner subgroup. Functional results in the stabilizer and loser groups did not present significant changes after the first year of follow-up.
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