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Moreno Menghini, Florian K. Sutter, Barbara Kloeckener-Gruissem, Johannes C. Fleischhauer, Malaika M. Kurz, Sandrine A. Zweifel, Stephan Michels, Wolfgang Berger, Daniel Barthelmes; Influence of a Loading Phase on Long-term Visual Acuity with Respect to Genetic and Clinical Factors in Patients with Neovascular Age-related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2011;52(14):5243. doi: https://doi.org/.
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The ideal treatment regimen in patients with neovascular age-related macular degeneration is still being investigated. Widely applied is a loading phase with initially three consecutive intravitreal injections of ranibizumab. The influence of genetic risk factors on AMD has been repeatedly published. Recent studies have shown a higher number of patients requiring re-injections. Furthermore, CFH genotypes have been implicated with a varying outcome. The purpose of this study was to compare the outcome of patients with loading phase to patients without with respect to genetic polymorphisms and clinical components.
Retrospective analysis of the clinical data of neovascular AMD patients treated with intravitreal ranibizumab during a follow up period of at least 12 months. Assessment of the injection frequency and course of VA was performed. Calculation of the proportion of patients having initially received three consecutive intravitreal injections (loading phase) of ranibizumab with allocation to two groups: Group 1 eyes with loading phase; Group 2 eyes without loading phase. Genotypes at SNP rs1061170 in CFH were identified and their frequency was compared between the two groups.
A total of 238 eyes were included in the final analyses with 62 eyes allocated to Group 1 and 176 eyes to Group 2. Demographic characteristics and baseline visual acuity were comparable between the two groups. The injection frequency over a period of 12 months showed a median of 5 (Interquartile-Range IQR [3;7]) in Group 1 and a median of 4 [2.5;6] in Group 2 (p=0.074). The median change in VA from baseline was 4 letters [-5;12] in Group 1 and 2 [-5;10] in Group 2 (p=0.463). 16 eyes (26%) in Group 1 carried the genotype CC CFH rs106117 as opposed to 51 (29%) in Group 2, (p=0.743). Eyes carrying the risk factor CC CFH in Group 1 showed a similar median outcome compared to Group 2: 0[-6;8] and -5[-8;6] (p=0.463).
Loading phase did not appear to influence positive treatment outcome. Furthermore, it seems that patients carrying the known AMD susceptibility locus CFH do not show a better improvement with a loading phase.
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