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Atsushi Otani, Tatsuya Yoshitake, Shoshinao Setoguchi; Efficacy of intravitreal ranibizumab injections (IVR) without initial loading doses in patients with neovascular age-related macular degeneration (wAMD). Invest. Ophthalmol. Vis. Sci. 2014;55(13):4946.
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To evaluate the 12- month efficacy of intravitreal ranibizumab injections (IVR) using a treatment regimen on as-needed (PRN) basis without initial loading doses in patients with neovascular age-related macular degeneration (wAMD).
Fifty-one eyes of 50 patients with exudative age-related macular degeneration (AMD) were included. The mean age of the patients was 72.9 years. All patients received initial IVR followed by retreatment on PRN basis. Retreatment criteria were any changes of retinal exudation on OCT or new macular hemorrhage. The patients were followed and checked every month with comprehensive ophthalmological examination, visual acuity measurement and OCT examination.
Mean VA improved at 12 month follow-up (63.9 letters vs 67.1 letters). VA stabilized or improved in 96% of the eyes. The number of IVRs was 3.67 per year and 27 eyes (54%) required less than four injections and showed significant improvement of VA during the follow-up. Eight eyes (15.9%) required only the initial treatment with the improvement of VA (69.5 letters vs 77.3 letters). The cases required smaller number of retreatments tends to have smaller wAMD lesions.
Although the patients should be checked every month, this treatment scheme reduces the number of IVRs without losing the effect in VA. As previously suggested, there are differences in the response to IVR among AMD cases and only initial single IVR is required to improve VA for 12 months in certain number of cases. Initial three loading doses of IVRs may not be necessary.
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