Ranibizumab and exudative age-related macular degeneration: five years multicentric functional and anatomical results in real-life practice in France.

Abstract

Purpose: The aim of this study was to investigate five years functional and anatomic outcomes of wet AMD patients treated by ranibizumab according to a pro re nata (PRN) regimen in a real-life practice.<br />

Methods: A retrospective, multicentric charts review of 201 eyes of 201 patients who underwent their first ranibizumab intravitreal injection (IVT) between 2007, January 1^st and 2008, December 31^th was realized. Best-corrected visual acuity (BCVA) evaluated by Early Treatment Diabetic Retinopathy Study (ETDRS) charts, central macular thickness (CMT) on spectral-domain optical coherence tomography (SD-OCT), number of IVT and follow-up visits were collected at base-line and during the whole follow-up period of 5 years.

Results: Mean BCVA at baseline was 52.3±16.5 letters. Mean BCVA change from baseline was respectively +2.8, +2.5, +1.8, - 0.6 at 1, 2, 3, 4 years of follow-up. At year 5, 43% of eyes had a stable or improved letter score (≥ 0 letter gain), whereas 29% declined by 15 letters or more, with an overall, significant mean decline of 2.8 letters (p<0.05). No correlation was observed between final visual outcome and age, baseline BCVA, type of neovascularization, number of IVT and number of follow-up visits. On SD-OCT, mean CMT was 293±96μm at baseline and was significantly reduced compared to baseline at each year end-point (p<0,005). The mean number of IVT was 15±10.4 at year 5, with 55% of eyes still being under active treatment. Including visits for injections, the mean number of visits was 37±4 over the 5 years period of follow-up, and 6±4 the 5^th year only. In this cohort, 54% of eyes had received previous treatments (photodynamic therapy, and/or laser photocoagulation, and/or intravitreal sodium pegaptanib) before the first ranibizumab injection. No difference in visual outcomes and number of IVT was observed when comparing naïve eyes with not-naïve eyes. Lastly, 52% (39/75) of eyes with unilateral choroidal neovascularization at baseline had the second eye involved at 5 years.

Conclusions: PRN ranibizumab in real-life practice improved or stabilized visual acuity during 4 years. During the 5^th year, progressive decline of visual acuity was observed. Compared to baseline, almost half of the eyes were stable at 5 years, whereas one third declined by 15 letters or more.<br /> <br />