title: Funduscopic results after 4-year follow-up treatment with ranibizumab for age-related macular degeneration in a region of Spain.
abstract: BACKGROUND
  The study aims to survey longstanding funduscopic and functional outcomes of age-related macular degeneration (AMD) after ranibizumab treatment and verify the accuracy of a new method to compare the retinal thickness measured with different optical coherence tomography (OCT) tools.
  
  
  METHODS
  Case series included 314 eyes with 2-4 years of follow-up. Main Outcome Measures were visual acuity (VA), number of injections, retinal thickness, OCT morphology, and final macular funduscopic status.
  
  
  RESULTS
  One hundred twenty-two men and 177 women (mean age, 78.3 years) were included. The mean time to the first injection was 17.3 ± 14.6 days. Initial VA was O.8(20/125) ± 0.5; 0.7(20/100) ± 0.5 at 3 months; 0.8(20/125) ± 0.5 at a year; 1(20/200) ± 0.6 at year 2; 1(20/200) ± 0.6 at year 3 and 1.1(20/250) ± 0.6 at year 4. Number of visits at 3 months was 2.7 ± 0.8; 7.3 ± 2.1 at a year; 5.2 ± 2.7 along the 2nd year; 3.9 ± 2.3 at year 3 and 3.6 ± 2.2 at year 4. Number of injections at 3 months was 2.6 ± 0.5; 3.9 ± 1.5 at a year; 1.1 ± 1.5 along the 2nd year; 1.5 ± 2.4 at year 3 and 1.8 ± 3.1 at year 4. Patients with worse VA outcomes received more injections and were older. The formula to calculate changes in retinal thickness showed a 30% reduction in thickness, which correlated well with the OCT morphology. Patients with polypoidal choroidal vasculopathy (PCV) had a worse final outcome. The final disciform macular status (37%) was related to fewer injections and a greater decrease in thickness. Final well-preserved maculas (12.%) needed more injections and treatment changes; those that were atrophic at the final visit (30.8%) had a worse initial VA and greater decrease in thickness at the 3-month visit.
  
  
  CONCLUSIONS
  Younger patients had better final outcomes. Our method to compare retinal thickness using different OCT tools worked well. The final visual outcome after a long follow-up was poor, which may be related to advanced age, poor initial VA, and the high incidence of final fibrosis or atrophy.
authors.affiliation: Instituto de Oftalmobiologia Aplicada, Universidad de Valladolid, Campus Miguel Delibes, P° de Belén n° 17, Valladolid 47011, Spain. rosa@ioba.med.uva.es.
authors.forename: Rosa M
authors.initials: RM
authors.lastname: Coco
authors.forename: M Rosa
authors.initials: MR
authors.lastname: Sanabria
authors.forename: Melissa
authors.initials: M
authors.lastname: Castrejon
authors.forename: M Isabel
authors.initials: MI
authors.lastname: Lopez-Galvez
authors.forename: Laura
authors.initials: L
authors.lastname: Monje-Fernandez
authors.forename: Marta
authors.initials: M
authors.lastname: Fernandez-Munoz
authors.forename: Alejandro
authors.initials: A
authors.lastname: Anton
authors.forename: Lourdes
authors.initials: L
authors.lastname: de Juan-Marcos
authors.forename: Sonia
authors.initials: S
authors.lastname: Villaron-Alvarez
authors.forename: Itziar
authors.initials: I
authors.lastname: Fernandez
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D005260:Female; D005451:Fluorescein Angiography; D005500:Follow-Up Studies; D006801:Humans; D058449:Intravitreal Injections; D008297:Male; D008875:Middle Aged; D009887:Ophthalmoscopy; D009929:Organ Size; D000069579:Ranibizumab; D012160:Retina / Q000473:pathology; D012189:Retrospective Studies; D013030:Spain; D041623:Tomography, Optical Coherence; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014792:Visual Acuity / Q000502:physiology; D057135:Wet Macular Degeneration / Q000188:drug therapy* / Q000503:physiopathology
chemical_list: D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D000069579:Ranibizumab