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Wolfgang Schrader, Adrian Bernhard, Clara Dietz, Karina Sommer, Ermioni Panidou; How bad are the long term results under real life conditions beyond 2 years of treatment for wet AMD with ranibizumab or bevacizumab? Results from a 4 year follow up of 77 patients. Invest. Ophthalmol. Vis. Sci. 2013;54(15):3822. doi: https://doi.org/.
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Visual acuity (VA) can be preserved by 4-weekly intravitreal injections (IVI) of ranibizumab over >2 years (yrs). The CATT-trial showed that a PRN (pro re nata) Treatment (TX) based on a monthly follow up (FU) is not inferior to a monthly IVI TX. In Germany, most insurance companies do not reimburse a monthly FU based on OCT. However, a PRN-TX based on visual acuity (VA) changes rather than OCT changes has less favourable results. The aim of this study is to investigate the long term development of wet AMD under real life conditions.
Retrospective analysis of 77 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 >4 yrs, the total number of IVI needed and the frequency of IVI in the 1st, 2nd , 3rd and 4th yr of TX.
88 eyes (77 patients, median age 78 yrs, mean 75.6 yrs, 45 females, 32 males) had a FU of >4yrs. Mean FU time was 4.33yrs. 12.6±7.3 IVI were performed within the FU-time. Mean no. of IVIs in 1st yr was 4.6±1.5 (range 3-8), in 2nd year 2.8±2.2 (range 0-8), in 3rd yr 2.7±2.5 (range 0-10) and in 4th yr 2.2±2.8 (range 0-10). 51/88 (58%) required 3 or more IVIs in yr 3, and 31/88 (35%) in yr 4. No significant increase of VA could be registered, as compared to a strict monthly OCT guided monitoring system. At least, VA remained stable over 2 yrs (LogMAR 0,64 at baseline, at 2 yrs 0.68), but then deteriorated to 0.84 at 4yrs. Patients younger than 78 yrs (mean 70.4±6.8 yrs) had a better baseline VA (LogMAR 0,54) and a better final VA (LogMAR 0,76) at 4yrs than those older than 77 (mean 82,4±3.1yrs, baseline VA 0.73, at 4yrs 0.92).
As in Germany neither monthly injections nor a monthly FU, based on OCT, was reimbursed by most insurance companies, our results based on a VA guided PRN TX were inferior to such a TX at 2 yrs. Younger patients have a more favourable outcome of VA after a 4yr TX of wet AMD. As a significant part of the patients require 3+ IVIs even in yr 3 and 4, we have to realize, that a close (monthly) monitoring is still necessary beyond two years of TX for a successful PRN-TX.
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