title: Measuring the benefit of 4 years of intravitreal ranibizumab treatment for neovascular age-related macular degeneration.
abstract: OBJECTIVE
  To analyse the benefit of intravitreal ranibizumab over 4 years for patients with neovascular age-related macular degeneration (AMD).
  
  
  METHODS
  A retrospective case note review of all patients who started treatment between August 2007 and September 2009 in our unit, minimum follow-up 2 years, maximum 4 years. The main outcome measures were: numbers of patients with different levels of vision, changes in visual acuity, number of treatments and numbers remaining under follow-up.
  
  
  RESULTS
  1086 eyes of 1017 patients received treatment. Numbers of patients remaining under follow-up were 892/1017 (87.71%) at 12 months, 730/1017 (71.78%) at 24 months, 468/730 (64.11%) at 36 months and 110/217 (50.69%) at 48 months. The main reasons for patients no longer being under follow-up were the consequences of old age or transfer of care. 50% of patients had 6/18 or better over 4 years. Patients received on average 5.79 ± 2.53, 9.15 ± 3.79, 11.22 ± 4.92 and 13.7 ± 7.84 injections by 12, 24, 36 and 48 months, respectively.
  
  
  CONCLUSIONS
  We suggest that the numbers of patients with a particular level of vision may best reflect the actual benefit of AMD treatment provided by a service. Long-term follow-up is required as only 72/730 (10%) had been discharged at 36 months, half of whom had good vision of greater than 60 letters. 83% and 65% of patients needed treatment in the third and fourth year. Follow-up may be for the rest of the patients' life or at some point they may no longer be well enough to attend.
authors.affiliation: Department of Ophthalmology, The Royal Victoria Infirmary, Newcastle upon Tyne, UK.
authors.forename: Sreekumari
authors.initials: S
authors.lastname: Pushpoth
authors.forename: Evripidis
authors.initials: E
authors.lastname: Sykakis
authors.forename: Kinnar
authors.initials: K
authors.lastname: Merchant
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Browning
authors.forename: Rajen
authors.initials: R
authors.lastname: Gupta
authors.forename: S James
authors.initials: SJ
authors.lastname: Talks
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage*; D005260:Female; D005451:Fluorescein Angiography; D005500:Follow-Up Studies; D005654:Fundus Oculi; D006801:Humans; D058449:Intravitreal Injections; D008268:Macular Degeneration / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D000069579:Ranibizumab; D012160:Retina / Q000473:pathology; D015861:Retinal Neovascularization / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014792:Visual Acuity / Q000187:drug effects*
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000069579:Ranibizumab