Predictors of 1-year visual outcome in neovascular age-related macular degeneration following intravitreal ranibizumab treatment.
OBJECTIVE
To describe predictors of visual outcome in patients treated with intravitreal ranibizumab for choroidal neovascularisation (CNV) in age-related macular degeneration (AMD).


METHODS
Retrospective review of 279 patients with CNV in AMD who fulfilled MARINA/ANCHOR study eligibility criteria and were treated with repeated intravitreal injections of ranibizumab 0.5 mg in routine clinical practice, beginning with three initial injections at 4-week intervals followed by individualized retreatment for the subsequent 9 months. Study parameters included best-corrected visual acuity (BCVA) and morphological characteristics.


RESULTS
Mean BCVA relative to baseline was +4.7 (p < 0.0001), +4.2 (p < 0.0001)and -0.4 (p > 0.667) Early Treatment Diabetic Retinopathy Study letters after 3, 6 and 12 months, respectively, after a mean of 5.1 injections when the proportion of patients with BCVA ≥ 70 letters had doubled compared with baseline. Predictive factors for BCVA ≤ 35 letters after 12 months were BCVA ≤ 35 letters at baseline and month 3 (p < 0.0001) while BCVA ≥ 70 letters at month 12 was associated with BCVA ≥ 70 letters at baseline and month 3 (p < 0.001) and with total lesion size <4 DA (p = 0.0147).


CONCLUSIONS
Under a ranibizumab regimen with substantially fewer injections than with fixed four-weekly injection regimens, BCVA was improved compared with the natural history of neovascular AMD, but did not achieve the visual gain observed in randomized clinical trials using fixed 4-week retreatment. Visual acuity at month 3, after the initial fixed-interval injections, was the strongest predictor of BCVA at month 12.
Department of Ophthalmology, Glostrup Hospital, Glostrup, Denmark University of Copenhagen, Copenhagen, Denmark. sabrbl01@glo.regionh.dk
Sara B
SB
Bloch
Morten
M
la Cour
Birgit
B
Sander
Louise K H
LK
Hansen
Josefine
J
Fuchs
Henrik
H
Lund-Andersen
Michael
M
Larsen
D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage* / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D058449:Intravitreal Injections; D008297:Male; D008875:Middle Aged; D000069579:Ranibizumab; D019233:Retreatment; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014792:Visual Acuity / Q000502:physiology*; D057135:Wet Macular Degeneration / Q000188:drug therapy* / Q000503:physiopathology
D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D000069579:Ranibizumab