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B. C. Braun, P. Hasler, U. Schneider, C. Prünte; Outcome of Ranibizumab (Lucentis®) Treatment in Patients With Choroidal Neovascularisation (CNV) Due to Age-Related Macular Degeneration (AMD) in a Clinical Routine Setting. Invest. Ophthalmol. Vis. Sci. 2007;48(13):1444.
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First treatments using ranibizumab (Lucentis®) in patients with neovascular AMD outside study protocols have been performed in Switzerland. Aim of this retrospective case series is to evaluate the outcome of this treatment in a clinical routine setting.
A total of 50 consecutive patients with subfoveal or juxtafoveal CNV of all lesion types were analysed. Follow-up was 6, respectively 12 months (April 2007). Patients received an initial loading dose of 3 monthly intravitreal injections of 0.3 mg ranibizumab. Thereafter, injections were only given, if there was a loss of visual acuity (VA) ≥ 5 letters, persistent or recurrent fluid in optical coherence tomography (OCT) and/or new haemorrhage or leakage in fluorescence angiography. Biomicroscopic evaluation, retinal thickness in OCT, and VA were initially performed on a monthly basis, after two examinations without an indication for re-treatment continuing on a three monthly basis. Fluorescence angiography was only performed on demand in case of diagnostic doubt.
In 88% of patients vision was stable (not loosing any letters) or improved by 1 or more letters. VA results showed rapid improvement with a mean gain of 10 letters after 6 months. Significant regression of retinal thickness was seen in all lesions during the first 3 months (average 120 µm). Biomicroscopic examination revealed that sub-retinal haemorrhages rapidly transformed into fibrosis and that large lesions tended to build fibrotic scars with limited functional results. A majority of patients spontaneously reported about improvement of colour vision and near activities. Re-treatment between months 3 and 6 was indicated in 25% of patients.
The outcome of this case serious in a routine clinical setting is similar to results obtained in phase III trials using ranibizumab. However, these results were obtained by an individualized treatment strategy resulting in a reduced re-treatment frequency. Further studies evaluating individualized re-treatment criteria are therefore suggested.
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