Comparison Of The Loading Regimen And A Single Dose Regimen In The Treatment Of Neovascular Age-related Macular Degeneration

Abstract

Purpose: : Currently, the loading regimen with 3 initial monthly intravitreal injections of ranibizumab has been widely recommended in the treatment of neovascular age-related macular degeneration (AMD). However, it is unknown that a single dose regimen would lead to a comparable functional and morphological retinal improvement. The purpose of this study is to compare the conventional loading regimen (3+PRN) and a single dose regimen (1+PRN).

Methods: : Patients, who were diagnosed with neovascular AMD with baseline best corrected visual acuity (BCVA) of 0.30-1.00 in the logarithm of minimal angle of resolution (logMAR) unit and treated with intravitreal ranibizumab as the primary treatment in Nagoya City University Hospital between April 2009 and March 2010, were enrolled. The mean age was 76.0±9.24 (range 51-94 ) years. Eight eyes of 8 patients were treated in 3+PRN regimen and 32 eyes of 29 patients in 1+PRN regimen. The mean follow up period was 13.7 (range 7-19) months. In the maintenance (PRN) phase, additional injection was performed when sRD was persisted, BCVA decreased, or new subretinal or retinal hemorrhage was observed. BCVAs at the baseline, in months 3 and 6, and at the last visit as well as the best post-treatment BCVA were analyzed. Photo dinamic therapy was performed combined with ranibizumab for 3 eyes.

Results: : Averaged number of injections were 4.75 ± 2.04(range 3-9) in 3+PRN regimen and3.44 ± 2.09 (range 1-11) in 1+PRN regimen. Mean BCVAs at the baseline, in months 3 and 6, and at the last visit were 0.66, 0.62, 0.55, and 0.59 in the 3+PRN regimen and 0.60, 0.56, 0.51, and 0.57 in 1+PRN regimen. The best post-treatment BCVA was 0.48 in 3+PRN regimen and 0.40 in 1+PRN regimen. Both regimens had no statistical difference in BCVAs at any time points.

Conclusions: : The results suggested that 1+PRN regimen lead to equivalent functional and morphological retinal improvement with less injection number, as compared with the 3+PRN regimen. Further studies are needed to determine an optimal treatment regimen for the first 3 months regarding intravitreal ranibizumabin the treatment of neovascular AMD.

Keywords: age-related macular degeneration • clinical (human) or epidemiologic studies: treatment/prevention assessment/controlled clinical trials • choroid: neovascularization