Visual Acuity Outcomes in Neovascular AMD Patients Receiving Series of Three Ranibizumab Injections on Indication

Abstract

Purpose: : The gold standard for wet age-related macular degeneration (AMD) treatment is monthly intravitreal injections of ranibizumab based on results of the Antibody for the Treatment of Predominantly Classic Choroidal Neovascularization in Age-Related Macular Degeneration (ANCHOR) and Minimally Classic/Occult Trial of the Anti-VEGF Antibody Ranibizumab in the Treatment of Neovascular AMD (MARINA) trials. It is unclear whether less frequent ranibizumab treatments can produce similar outcomes. We present outcome data for wet AMD patients treated serially with sequences of 3 monthly ranibizumab injections when active exudative was present.

Methods: : We identified patients who were initially treated July 2006-February 2007 with serial sequences of 3 monthly intravitreal ranibizumab injections as needed based on fundus examination, fluorescein angiography and optical coherence tomography. Patients were divided into 3 groups based on initial visual acuity (V_A). Differences between logarithm of the minimal angle of resolution (LogMAR) values of initial and final V_A were analyzed using the one tailed paired t-test statistic.

Results: : Including all 290 eyes, LogMAR improved by 0.033 (p=0.046) with 4.6 injections/year on average; 84% lost <15 letters and 24% gained ≥15 letters. In the 72 eyes with initial V_A ≥20/60, LogMAR deteriorated by 0.075 (p=0.0069) with 4.6 injections/year on average; 86% lost <15 letters and 4% gained ≥15 letters. In the 90 eyes with initial V_A between 20/60 and 20/200, LogMAR deteriorated by 0.012 (p=0.37) with 4.9 injections/year on average; 79% lost <15 letters and 17% gained ≥15 letters. In the 128 eyes with initial V_A ≤20/200, LogMAR improved by 0.13 (p=0.000033) with 4.3 injections/year on average; 84% lost <15 letters and 39% gained ≥15 letters.

Conclusions: : These results suggest that treatment of wet AMD on indication with series of 3 monthly ranibizumab injections results in stabilization or improvement of V_A on average. The proportion of individuals realizing a gain ≥15 letters was greater in patients who presented with poorer baseline visual acuities.

Keywords: age-related macular degeneration • vascular endothelial growth factor • injection