Predictive Value of Retinal Morphology for Visual Acuity Outcomes of Different Ranibizumab Treatment Regimens for Neovascular AMD.
OBJECTIVE
To establish the predictive value of defined retinal morphologic parameters on visual outcomes and re-treatment needs in patients with neovascular age-related macular degeneration (nAMD) receiving ranibizumab treatment.


METHODS
Post hoc analysis of a prospective, 12-month, multicenter, phase IIIb trial.


METHODS
Three hundred fifty-three treatment-naïve patients with nAMD.


METHODS
Available data from 319 treatment-naïve patients receiving ranibizumab 0.3 mg monthly (frequent regimen; n = 102) or ranibizumab 0.3 or 0.5 mg quarterly (pooled 0.3/0.5 mg = infrequent regimen; n = 217) were analyzed to assess the correlations between baseline retinal morphologic parameters and best-corrected visual acuity (BCVA) change (structure-function correlations). The BCVA was measured at monthly visits. Optical coherence tomography scans were acquired monthly for quantitative measures of the central retinal thickness and qualitative assessment of retinal morphologic features. Assessed morphologic parameters included intraretinal cystoid fluid (IRC), subretinal fluid (SRF), pigment epithelial detachment, and vitreomacular interface configuration classification comprising vitreomacular adhesion and posterior vitreous detachment (PVD). An analysis of covariance was conducted to evaluate the impact of retinal morphologic features on BCVA change at month 12.


METHODS
Change in BCVA from baseline to month 12 compared between frequent and infrequent treatment arms.


RESULTS
Relevant predictive factors for BCVA change at month 12 were baseline SRF (P = 0.05), PVD (P = 0.03), IRC (P = 0.05), treatment frequency (P < 0.01), and BCVA (P < 0.01). The presence of both SRF and PVD at baseline was associated with similar BCVA gains regardless of treatment frequency (mean difference in BCVA gains at month 12 of +2.6 letters in favor of infrequent treatment). Subretinal fluid was present in 71% of patients, and PVD was present in 64% of patients.


CONCLUSIONS
In patients with both SRF and PVD at baseline, similar BCVA outcomes were observed regardless of treatment frequency. These patients may require less frequent treatments compared with patients without SRF, without PVD, or without either who may require more frequent injections for maintenance of vision. This finding may have implications in clinical practice by helping to tailor an individualized re-treatment interval in nAMD patients.
Christian Doppler Laboratory for Ophthalmic Image Analysis, Department of Ophthalmology, Vienna Reading Center, Vienna, Austria.
Sebastian M
SM
Waldstein
Numerus Ltd, Wokingham, United Kingdom.
Jonathan
J
Wright
Novartis Pharma AG, Basel, Switzerland.
James
J
Warburton
Novartis Pharma AG, Basel, Switzerland.
Philippe
P
Margaron
Christian Doppler Laboratory for Ophthalmic Image Analysis, Department of Ophthalmology, Vienna Reading Center, Vienna, Austria.
Christian
C
Simader
Christian Doppler Laboratory for Ophthalmic Image Analysis, Department of Ophthalmology, Vienna Reading Center, Vienna, Austria. Electronic address: ursula.schmidt-erfurth@meduniwien.ac.at.
Ursula
U
Schmidt-Erfurth
D000293:Adolescent; D000328:Adult; D000368:Aged; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D058449:Intravitreal Injections; D008268:Macular Degeneration / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D000069579:Ranibizumab / Q000008:administration & dosage*; D012160:Retina / Q000473:pathology*; D015861:Retinal Neovascularization / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D013997:Time Factors; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D014792:Visual Acuity
D020533:Angiogenesis Inhibitors; D000069579:Ranibizumab