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Yasir Khan, Minji Jennifer Kim, Swan Kang, Sheena George; Evaluating safety and efficacy of intravitreal Ranibizumab injection in AMD patients and recommendations to improve the standards of AMD service. Invest. Ophthalmol. Vis. Sci. 2013;54(15):6305.
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Guidelines on the use of Ranibizumab for treatment of wet AMD recommends frequent follow-up and prompt initiation of treatment which has posed challenges for AMD services. The aim of this study was to evaluate the efficacy and safety of intravitreal injection of Ranibizumab for patients with wet ARMD and to assess the length of time between referral and first treatment.
Retrospective analysis was performed on 160 eyes of 149 patients undergoing repeat Ranibizumab injections attending two -stop AMD service clinic at Western Eye Hospital, London, over 12 months period. Patients with wet AMD (classic, predominantly classic and occult lesions involving the central fovea) with visual acuity range of 0.3 to 1.2 logMar were included in study. Patients fulfilling treatment criteria received 3 consecutive monthly Intravitreal Ranibizumab injections (loading dose) and then were followed up on a monthly basis. Patients were re-injected, if increase in CRT on OCT or drop in visual acuity were noted on follow up visit (PrONTO trial).
62% of patients were female and 37% were male with average age of 82.5 years. An average of 5.1 injections (range 3-10) was administered during the first year and no case of endophthalmitis occurred. Average number of days from initial referral to AMD clinic assessment was 12 days and an average time from initial assessment to first injection was 7 days. Therefore the average time interval from initial referral to first treatment was 19 days. The mean visual acuity improved by 8.5 letters and 29% of patients improved their visual acuity by 15 or more letters. Average central retinal thickness on OCT was 341.5μm at initial assessment and reduced to 250.9μm at 12 month.
Intravitreal Ranibiuzamb injections appear to be a safe and efficacious intervention for patients with wet AMD leading to stabilisation of vision, in a condition that otherwise leads to severe loss of central vision. One -stop AMD service was introduced to achieve rapid referral and prompt treatment intervention. On line referral pathway was implemented which reduces time interval from referral to treatment to within 2 weeks.
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