Purchase this article with an account.
A.-D. T. Phan, D. J. Jacobs, J. Z. Forsey, K. M. Bowman, G. B. Russell; A Modified "Treat and Wait" Approach for Neovascular Age-related Macular Degeneration with Ranibizumab (Lucentis). Invest. Ophthalmol. Vis. Sci. 2009;50(13):2381.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
To evaluate a modified as-needed Lucentis dosing strategy for neovascular age-related macular degeneration (AMD).
IRB-approved retrospective, non-comparative, consecutive series chart review of patients with neovascular AMD treated with monthly Lucentis intravitreal injections. Inclusion criteria were subfoveal or juxtafoveal lesions with active leakage (all CNV types), no subfoveal atrophy or fibrosis, Snellen BCVA of 20/400 or better, and at least 9 months of follow-up. Monthly intravitreal Lucentis was administered until a fluid-free macula was confirmed by FA and OCT (usually more than 3 injections). Patients were then monitored less frequently: 6 weeks, 6 weeks-3 months, 3 months, 3-6 months. Monthly Lucentis injections were restarted as-needed based on clinical as well as OCT +/- FA evidence of leakage recurrence. Primary outcome measure was mean Snellen letter change. Secondary outcome measures were Snellen vision loss less than 15 letters, mean OCT central foveal thickness change, and mean injection-free interval. Comparisons between baseline and 9-month data used a paired t-test to assess the significance of the change.
18 patients received 9 months or more of follow-up. At month 9, the mean Snellen visual acuity improved by 10.9 (SD +/- 15.7) letters, p=0.009 (mean logMAR change -0.21, p=0.04). 94% of patients lost less than 15 letters. 33% of patients gained 15 or more letters. These vision gains were achieved with a mean number of 4.5 (+/- 0.9) treatments. Mean OCT central foveal thickness decreased by 61 (+/- 53) µm, p=0.001. After a fluid-free macula was achieved, recurrent leakage developed in 36% (5/14) patients within the first 3 months, with a mean injection-free interval of 5.4 (+/- 2.9) months before another reinjection was necessary.
This modified "treat and wait" approach for neovascular AMD appears to maintain vision gains obtained with monthly Lucentis while providing a schedule for monitoring patients less frequently after a fluid-free macula is achieved. This new dosing strategy appears to catch leakage recurrence effectively. 12-month data will be presented at the meeting.
This PDF is available to Subscribers Only