Non Responder Patients To Ranibizumab Therapy In AMD: Baseline Lesion Characteristics And Visual Function

Abstract

Purpose: : To evaluate morphological and functional characteristics of exudative AMD in patients non responders to IntraVitreal Ranibizumab (IVR).

Methods: : In this retrospective study we included 85 eyes of 85 consecutive patients (mean age 74,6± 6,5) treated for active CNV in AMD. All patients underwent a loading dose of 3 IVR (2.3 mg/0.23ml), one every 30 days. We divided patients into three groups according to visual acuity variation as result parameter: Group 1 Responders (R, 23 patients) with a visual acuity (VA) increase more than 1 line, Group 2 Stable (S, 43 patients) and group 3 Non Responders (NR, 19 patients) with a loss of VA more than 1 line. At baseline and at month 4 we studied on each group different responsivity parameters: macular thickness and subretinal fluid on OCT examination, lesion morphology and leakage on fluorescein angiography.

Results: : In Group 1 we found at baseline a mean VA of 0.44±0.19logMAR, macular thickness (MT) of 407,04±167,80µm and mean lesion size (LS) of 5,51±4,21mm²; 3 patients presented a significative subretinal haemorrhage (SSH); no Pigment Epitelium Detachment (PED) was detected. At month 4 mean VA was 0.27±0.15LogMAR, MT 201,74±89,68µm and LS 3,91±3,63mm². In Group 2 baseline mean VA was 0.43±0.23logMAR, MT 368,48±143,88µm and LS 7,46±5,49mm²; 12 patients presented a PED and 2 a SSH. At month 4 mean VA was 0.43±0.23logMAR, MT 268,33±151,83µm and LS 6,92±4,08mm². In Group 3 mean VA was 0.33±0.17logMAR; MT 331,18±109,75µm and LS 9,74±9,03mm²; 2 patients had a SSH and none a PED. At month 4 mean VA was 0.53±0.19 MT 259,41±110,08µm and LS 10,08±9,85mm².

Conclusions: : Our study showed that the efficacy of IVR primary depends on initial lesion size: NR and S Groups presented a significative larger lesion size than the R group. OCT analysis showed that the presence of intraretinal edema didn’t represent a worsening parameter; in all groups we appreciated a significative reduction of macular thickness after 3 IVR. Finally we didn’t find a significative role of VA as predictive parameter of responsivity to ranibizumab treatment: as functional parameter it depends on the evolution of morphology and activity of the lesion.

Keywords: age-related macular degeneration • imaging/image analysis: clinical • vascular endothelial growth factor