Visual outcomes of ranibizumab treatment in fellow eyes of exudative AMD

Abstract

Purpose: To evaluate 12 month visual acuity outcomes of fellow eyes compared to first eyes in patients receiving intravitreal ranibizumab for exudative age-related macular degeneration (AMD).

Methods: Retrospective review of patients with exudative AMD initiated on ranibizumab treatment between June 2007 and March 2008 at a tertiary retinal clinic. Patients who were diagnosed with choroidal neovascularisation (CNV) bilaterally and were anti-VEGF treatment naïve were included in the study. All patients were followed for 12 months in both eyes. Best corrected visual acuity (BCVA) was converted to visual acuity score (VAS). Eyes with VAS > 85 letters (“Good vision group”, Snellen VA >6/12) at baseline in both the first and fellow eyes were further analysed for BCVA change.

Results: 46 patients met inclusion criteria. Mean interval of CNV diagnosis between the fellow eye and the first eye was 461+/-378 days, and the mean time between the fellow eye diagnosis and the previous clinical review was 47+/-20 days. There was no statistically significant difference in the mean baseline VAS between these two groups (First eye=70 letters, Snellen acuity 6/17 and the second eye =77 letters, Snellen 6/13) (p=0.101), nor with the 12-month mean BCVA (VAS=72 letters in the first eye and 76 letters in the fellow eye) (p>0.05). At baseline, 15 first eyes and 22 fellow eyes were categorised in the “Good Vision Group”. Of these patients, 8 first eyes (53%) and 18 fellow eyes (82%) remained in this group at 12 months. Mean VAS change at 12 months compared to baseline was -9 letters in the first eyes (p=0.024) and -3 letters in the fellow eye group (p=0.206).

Conclusions: Intravitreal ranibizumab was able to maintain sight in both first and second eyes. In the subcategory of patients with good baseline VA, the first eyes significantly declined at 12 months, whilst the majority of fellow eyes maintained their baseline visual level at 12 months. Regular assessment of the fellow eye may result in early detection of CNV and better treatment outcomes.

Keywords: 453 choroid: neovascularization • 748 vascular endothelial growth factor • 585 macula/fovea