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Stefano Erba, Giulia Delledonne, Carlo Domenico Bianchi, Mariano Cozzi, Alessandro Babbi, Mario V Cigada, Ferdinando Bottoni, Giovanni Staurenghi; Recurrences in neovascular age related macular degeneration: are they predictable in a clinical setting?. Invest. Ophthalmol. Vis. Sci. 2016;57(12):3356.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the first recurrence in naive neovascular AMD after three loading doses of Ranibizumab and to assess the risk of subsequent recurrence through retrospective review.
Design of the study: retrospective review. 93 eyes (87 patients) with naïve CNV (occult-type 1 n=46, classic-type 2 n=23, Retinal Angiomatous Proliferation (RAP)-type 3 n=19 and polypoidal choroidal vasculopathy (PCV) n=5) with no sign of activity (e.g. any intra-, sub-retinal fluid on SD-OCT, new hemorrhage, reduction in visual acuity attributable to neovascular AMD or leakage on fluorescein angiography) after the three loading doses of ranibizumab were enrolled. Only patients with a follow up of 30-45 days between every visit for at least 1 year were included. Recurrences were retreated in pro re nata (PRN) regimen. Exclusion criteria included any previous ophthalmic surgery, except for cataract removal. Eyes with any previous treatment for neovascular AMD (e.g. focal laser, photodynamic therapy, other type of anti-VEGF drugs) were excluded. Survival for the first recurrence was estimated by Kaplan-Meier analysis. Coefficient of variation of the mean recurrence interval was calculated for every patient.
The mean age of patients was 79 years (range 62-91). Mean follow up time was 978 days (range 476-1725). Kaplan Meier analysis showed that the 50% (CI 40%-60%) of neovascular lesions showed signs of reactivation by the forth month (120 days) after the third injection. Subgroup analysis showed that 50% type 3 lesions reactivated by the day 107, type 1 by the day 126, type 2 by the day 175 and PCV by the day 217. Coefficient of variation of the mean recurrence interval was 0,52, interquartile range (IQR) 0,33-0,63.
Although this is a small cohort of patiens with neovascular AMD, our data suggest a clear trend in the first recurrence. RAP-type 3 showed recurrence earlier than occult-type 1 or classic-type 2 lesions. PCV lesions, although a small sample in this cohort, showed a larger interval for the first recurrence. These data may be used to plan a tailored follow up visit after the three loading doses of ranibizumab. Coefficient of variation of the mean recurrence interval showed large intra-individual fluctuations. Recurrences of the neovascular lesions cannot be predicted only on the basis of the first year of follow up.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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