title: Clinical risk factors for poor anatomic response to ranibizumab in neovascular age-related macular degeneration.
abstract: OBJECTIVE
  To identify OCT-based anatomical features and clinical characteristics for poor central retinal thickness (CRT) response to ranibizumab in neovascular age-related macular degeneration (AMD).
  
  
  METHODS
  Investigating our electronic patient records (Eyeswide), patients with neovascular AMD treated with intravitreal injections of 0.5mg/0.05ml ranibizumab were identified and their notes reviewed. Data collected included gender, age, initial best-corrected visual acuity (BCVA), prior photodynamic therapy, lesion type (classic versus occult), type of macular edema (intraretinal fluid, subretinal fluid, pigment epithelium detachment) and the total number of previous ranibizumab injections.
  
  
  RESULTS
  A total of 210 eyes of 182 patients with neovascular AMD were identified. Mean follow-up time was 1.34 years (SD ± 0.77). Central retinal thickness reduction in women was significantly inferior to that in men (p=0.05). Patients with cystoid type macular edema had significantly greater reduction in CRT compared to patients with subretinal fluid (p<0.001) or pigment epithelium detachment (p<0.001). The percentage drop of CRT was no longer statistically significant after the sixth injection. Age, initial BCVA, prior photodynamic therapy and lesion type had no statistically effect on CRT response.
  
  
  CONCLUSIONS
  Risk factors for poor central retinal thickness response to ranibizumab include female gender and patients with predominant subretinal fluid or pigment epithelium detachment. Furthermore, the anatomical response decreased after the sixth injection of ranibizumab.
authors.affiliation: Sutton Eye Hospital, Epsom and St Helier University Hospitals, London, UK.
authors.forename: Josef
authors.initials: J
authors.lastname: Guber
authors.affiliation: Department of Ophthalmology, University of Basel, Basel, Switzerland.
authors.forename: Tatjana
authors.initials: T
authors.lastname: Josifova
authors.affiliation: Department of Ophthalmology, University of Basel, Basel, Switzerland.
authors.forename: Paul Bernhard
authors.initials: PB
authors.lastname: Henrich
authors.affiliation: Eye Clinic, Cantonal Hospital of Winterthur, Winterthur, Switzerland.
authors.forename: Ivo
authors.initials: I
authors.lastname: Guber
keywords: Age-related macular degeneration; Lucentis; poor-responder; ranibizumab; risk factors.