Abstract
Purpose::
To report on the OCT and angiographic features and consequences of recurrent ARMD-related CNV in patients who completed 24 monthly intravitreal ranibizumab injections.
Methods::
Following completion of 24 monthly injections of ranibizumab, patients at our institution had treatment withdrawn. All cases were observed monthly, and had imaging with OCT and FA as well as ETDRS acuity testing performed every other month for evidence of recurrent CNV regardless of symptoms. Recurrent CNV was treated based on ETDRS best corrected visual acuity scores, complaints of recurrent metamorphopsia, OCT findings of increased fluid, and FA findings of reactivated CNV.
Results::
Of the 9 consecutive patients who completed 24 months of ranibizumab, 7 experienced recurrence of CNV requiring retreatment. In all 7 retreated patients OCT was the initial objective evidence of CNV and recurrence was clearly seen. OCT findings improved with retreatment. 6 of 7 patients had either stabilization or improvement of visual acuity over the retreatment period (2 patients and 4 patients, respectively). Retreatment was stopped after resolution of fluid on OCT (mean=10 wks; median=14 wks). However, at the end of the retreatment period, 3 of 7 patients had a worse visual acuity compared to their visual acuity at the end of the initial treatment period. Of the remaining 6 patients who completed retreatment, 3 eventually developed a second recurrence of CNV, after an average (mean=median=26 wks).
Conclusions::
Long term treatment of ARMD-related CNV with ranibizumab is effective and safe for at least two years. However, after cessation of long term treatment, CNV recurs and is most evident on OCT which usually correlates with symptoms of recurrent metamorphopsia. Recurrences are common after both an extensive initial treatment period (24 months), and even following a retreatment period of several additional months. Data recently presented at the 2007 AAO meeting shows that, at 6 months, 40% of "ranibizumab experienced" patients (received drug during initial trials) enrolled in the HORIZON trial required at least one additional injection with ranibizumab. While periodic retreatment for recurrent ARMD-related CNV reactivation may yield good OCT results, this approach may not offer the same visual acuity results as ongoing maintenance therapy.
Keywords: age-related macular degeneration • choroid: neovascularization