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G. Katz, L. Giavedoni, R. Muni, T. Evans, M. Pezda, A. Moffat, D. Wong, F. Altomare, S. Boyd, A. Berger; A Retrospective Study to Compare 1 Year Visual Outcomes Between Monthly vs. Variable Dosing Ranibizumab. Invest. Ophthalmol. Vis. Sci. 2010;51(13):899.
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To evaluate the visual results of monthly ranibizumab injections compared with a variable dosing schedule for the treatment of neovascular age-related macular degeneration (AMD).
This is a retrospective study that compared two cohorts of consecutive patients treated for exudative AMD at a tertiary retinal referral centre. All patients started their treatments between December 2007 and October 2008. Patients were eligible for the study if they were treatment naïve, with baseline VA of 20/400 or better, and completed 12 months of therapy. All patients had a baseline fluorescein angiogram (FA) and optical coherence tomography (OCT) done. In the first group (Group A), all patients received monthly injections, and every 4 months underwent a repeat FA and OCT study. In the other group (Group B), after 3 monthly loading doses were given, a variable dosing schedule was used. It was based on a monthly clinical retinal assessment to look for subretinal or intraretinal blood and an OCT test to look for any subretinal fluid or intraretinal cysts. Patients received another injection if any of these findings were present.
Forty four consecutive patients (45 eyes) were included in the study. Group A included 23 patients (24 eyes) and Group B included 21 patients (21 eyes). The mean baseline LogMAR VA was similar in the two groups: 0.95 (Snellen equivalent 20/178) in the monthly treated group and 0.93 (Snellen equivalent 20/170) in the variable dosing group. At 12 months the median injections numbers were 12 and 7 respectively. At the 12th month visit the mean change in Snellen visual acuity was an improvement of 0.32 LogMAR (16 ETDRS letters equivalent) in the monthly treated group vs 0.27 LogMAR (13 ETDRS letters equivalent) improvement in the variable dosing group (P = 0.6). None of the 45 eyes in the study lost more than 0.3 LogMAR visual aquity (equivalent to 3 ETDRS lines). Fifteen eyes (62%) in group A recovered more than 0.3 LogMAR VA (equivalent to 3 ETDRS lines) vs 8 eyes (38%) in group B (p=0.14). All eyes in group A preserved equal or gained VA (100%) vs 17 eyes (81%) in group B (p=0.04).
We were able to show that in our clinical setting patients achieved similar visual acuity results to the ANCHOR and MARINA studies with either monthly injections or with a PRN variable dosing protocol. There was a trend towards better results with a monthly treatment protocol vs variable dosing.
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