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Cinzia Mazzini, Lucia Finocchio, Daniela Bacherini, Giovanni Giacomelli, Fabrizio Giansanti, Ilaria Biagini, Lorenzo Vannozzi, Gianni Virgili, Ugo Menchini; RESULTS OF INTRAVITREAL RANIBIZUMAB WITH A PRN REGIMEN IN THE TREATMENT OF EXTRA AND JUXTAFOVEAL NEOVASCULAR MEMBRANES IN AGE-RELATED MACULAR DEGENERATION. Invest. Ophthalmol. Vis. Sci. 2013;54(15):3815.
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To evaluate the efficacy of intravitreal ranibizumab with a pro re nata regimen (PRN) in the treatment of naïve extra or juxtafoveal neovascular membranes secondary to age-related macular degeneration (AMD).
Retrospective, non comparative case series. 31 eyes of 31 patients (mean age 77.0 years, SD:6.7) with naïve neovascularization secondary to AMD were enrolled and treated with ranibizumab intravitreal injections with a PRN regimen. We reviewed 23 choroidal neovascular membranes(CNV) and 8 retinal angiomatous proliferation(RAP).16 lesions were extrafoveal and 15 were juxtafoveal. The follow-up was at least 12 months and it was performed monthly up to 6 months and then quarterly. Best corrected ETDRS visual acuity (BCVA) and lesion size analysis with fluorescein angiography (FA) were recorded before treatment and at 3, 6, 12 and 24 months after first injection.
The mean baseline BCVA worsened from 0.28 LogMAR (SD:0.19) at baseline to 0.42 LogMAR (SD:0.33) at 1-year follow-up (P=0.024). BCVA was 0.53 LogMAR (SD:0.44) at 2-years follow-up. Overall visual acuity improved by at least one line in 7 cases(22.6%), it remained unchanged in 7 cases(22.6%) and it worsened in 17 cases(58.8%) at 1-year follow-up. 5 patients showed a slight improvement in visual acuity(20%), VA remained stable in 7 cases(28%) and it worsened in 13 cases(52%) at 2-years. The mean lesion size increased from 1.19 sq mm(SD:1.24 sq mm) at baseline to 2.07 sq mm(SD:2.21 sq mm) at 1-year follow-up (P=0.49), up to 2.47 sq mm(SD:2.56 sq mm) (P=0.01). 9 patients developed a recurrence at 6 months and 26 patients had one or more relapses at 1-year follow-up. Only in 5 cases the disease remained stable after 3 injections of loading phase. None of the 25 patients with 2-years follow-up was immune from relapse. The mean number of injections was 5.1(SD:1.4).
Intravitreal ranibizumab with a PRN regimen in nonsubfoveal neovascular membranes was effective in maintaining BCVA level only up to 6 months of follow-up. However we registered a statistically significant VA decrease both at 1-year and at 2-years follow-up. Therefore we believe that controls have to be made monthly in a ranibizumab PRN regimen for nonsubfoveal neovascular membranes secondary to AMD. A different regimen, such monthly injections or a treat and extend one, should be adopted.
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