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I. Mantel, A. Mariani, A. Deli, A. Ambresin; Evaluation of Ranibizumab Treatment for Exudative Amd in Clinical Practice : Outcome and Influencing Factors in an Individualized Treatment Regimen. Invest. Ophthalmol. Vis. Sci. 2010;51(13):78.
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Background: Treatment of age related macular degeneration (AMD) with intravitreal Ranibizumab is associated with conflict between best outcome under intensive treatment and its acceptability for patient and doctor. Therefore most centers use an individualized treatment regimen according to need, encouraged by the PrONTO Study. However, not all individualized approaches were associated with a good mean result. The intention of this study is to evaluate our clinical routine practice and to search for factors associated with efficacy loss during follow-up.
Retrospective analysis of 99 patients with exudative AMD, treated with intravitreal ranibizumab and followed in clinical routine practice over a minimum of 12 months, with a re-treatment attitude according to need, as guided by OCT (injection as soon as any sub- or intraretinal fluid appeared on OCT).
Mean 12-month visual acuity (VA) gain was +6.8 letters (SE 1.56), comparable with the Marina Study. However, the results droped slightly at the final visit to +4.0 letters. Mean follow-up time was 21.3 months (range 12- 40.1 months). There was a clear association between the 3-month response and the 12-month outcome (p<0.001, R2 0.51) and final outcome (p<0.001, R2 0.47).Multiple logistic regression showed more pronounced VA gain for patients with lower initial VA (p=0.035) and those with a larger maximal decrease in OCT thickness (p=0.013) (corrected for age and lesion size). Trying to explain the mild drop of final VA benefit by prolonged follow-up intervals (mean 44 days, SD 7), or increased OCT variations (SD per patient - mean 40µm), or a reduced number of injections (mean 6 inj /year, SD 2), or the presence of factors of poor prognosis (subfoveal fibrosis, atrophy, large bleeding, 13 patients), or pseudophakia, we did not find any significant association.
The results allow a comparison of the real life scenario with the ideal situation of the multicenter studies Marina and Anchor. Overall, OCT-guided reinjections as needed allow good results over 12 months. The main prognostic factor appears to be the initial VA, the VA response at 3 months, and the degree of maximal OCT-thickness change. The mild final VA drop may be related to a selection bias of patients needing a long-term follow-up.
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