Evaluation of safety and efficacy of intravitreal Ranibizumab injections in AMD patients and recommendations to improve the standards of delivery of AMD service.

Abstract

 

Purpose

 

To assess and compare the efficacy and safety of intravitreal injections of Ranibizumab (IVR) for patients with wet AMD presenting between 2011-2013 in the macula clinic at the Western Eye Hospital and determine the interval between referral and first treatment comparing the two-stop clinic model with a one-stop.

 

Methods

 

Comparative retrospective analysis of 273 Ranibizumab treated eyes of 252 patients attending the one and the two-stop AMD clinic over 2 year period was performed. 103 patients attended the one stop clinic and 149 patients the two-stop. Patients with wet AMD with visual acuity (VA) range of 0.3 to 1.2 logMar were included. Patients fulfilling treatment criteria received 3 consecutive monthly IVR and followed up monthly. Patients were re-injected if there was an increase in central retinal thickness (CRT) on OCT or drop in VA.

 

Results

 

In the two-stop clinic an average of 5.1 injections was administered during the first year. The average time from initial referral and treatment was 19 days. No case of endophthalmitis occurred. In the one-stop clinic the average number of injections was 4.8, the average time from initial referral and treatment was 11 days with one case of endophthalmitis. In the two-stop clinic the mean VA improved by 8.5 letters. The VA improved by 15 or more letters in 29% of patients. The average CRT on OCT was 341.5μm at initial assessment and reduced to 250.9μm at 12 month. In the one-stop clinic the mean VA improved by 5 letters and 29% improved their VA by 15 or more letters. The average CRT on OCT was 357.07μm at initial assessment and reduced to 257.7μm at 12 month. In general, 90.3% of patients treated in the one-stop clinic lost less than 15 letters compared with 82.4% of patients in the two-stop clinic.

 

Conclusions

 

The reduction in the visual acuity gained in the one-stop clinic is explained by prompt treatment, with better visual acuity at presentation. This study recommends the introduction of a one-stop AMD service to achieve rapid referral and prompt treatment within 2 weeks to optimise visual outcomes.

 

 

OCT scan showing reduction in the central retinal thickness and resolution of the subretinal fluid following the loading dose with intravitreal Ranibizumab.

 

 

FFA of the left eye showing early hyperfluorescence and late leakage corresponding to active choroidal neovascular membrane.

 

Keywords: 754 visual acuity • 412 age-related macular degeneration