A Retrospective Study of Changes in Macular Structure and Function in Patients with Neovascular Age-Related Macular Degeneration Prior to Commencing Ranibizumab Therapy

Abstract

 

Purpose:

 

Describe changes in visual acuity and macular thickness in patients with neovascular age-related macular degeneration (nAMD) prior to initiating ranibizumab therapy and to describe the 12 month outcomes of therapy in this cohort.

 

Methods:

 

Retrospective non-interventional case series of eyes of 59 consecutive patients commencing treatment for nAMD with ranibizumab in 2008. The visual acuity and spectral-domain optical coherence tomography retinal thickness were recorded at the diagnosis, at the first injection visit and after one year as were demographic data and lesion sub-type.

 

Results:

 

The mean (range) age of patients was 78 (46-99) years with 33 (56%) females and 26 (44%) right eyes. There were 14 (24%) patients with classic or predominantly classic lesions with 45 (76%) with minimally classic or occult lesions. The mean (median) time to treatment from diagnosis was 55 days (45) . The mean (SD) change in visual acuity and central macular thickness (CMT) between diagnosis and treatment was -3 (15) letters and +37 (66) µm respectively. There were 18 (31%) patients with a 10 or more letter loss of vision (treatment initiated in less than 4 weeks in 2 of these patients) with 8 (14%) with a 100 µm or more increase in CMT prior to commencing treatment. For the 14 (24%) patients treated in 4 weeks or less, there were 2 patients (14%) with a 10 or more letter loss in vision with a mean change in vision of +1 letters. For the 45 (76%) patients treated in more than 4 weeks, there were patients 16 (36%) with a 10 or more letter loss in vision with a mean change in vision of - 4 letters from diagnosis to treatment.For the 18 patients who lost 10 or more letters from diagnosis to treatment, after 1 year of therapy 15 (83%) patients gained 10 or more letters (mean change +19 letters from first injection to one year). In this subgroup, 5 (28%) patients gained 10 or more letters from initial diagnosis to one year (mean change -0.2 letters).

 

Conclusions:

 

This was a historical study of patients with nAMD at the time when ranibizumab therapy was being introduced into clinical practice. Adverse changes in macular structure and function were observed in patients between diagnosis and initiation of ranibizumab therapy in this cohort of patients with nAMD. This work reinforces the need for prompt treatment of this condition.

 

Keywords: age-related macular degeneration • injection • clinical (human) or epidemiologic studies: outcomes/complications