title: METAANALYSIS OF REAL-WORLD OUTCOMES OF INTRAVITREAL RANIBIZUMAB FOR THE TREATMENT OF NEOVASCULAR AGE-RELATED MACULAR DEGENERATION.
abstract: OBJECTIVE
  To report the efficacy and safety of intravitreal ranibizumab for neovascular age-related macular degeneration (nAMD) in real-world practice.
  
  
  METHODS
  Metaanalysis of ∼26,360 patients from 42 real-world observational studies reporting outcomes of intravitreal ranibizumab for nAMD published between 2007 and 2015. Baseline demographics, lesion type, and visual acuity (VA) were recorded. The weighted mean was calculated for change in VA and frequency of injections and visits during year 1, year 2, and ≥3 years. Local and systemic adverse events were recorded.
  
  
  RESULTS
  The mean change in VA for patients receiving a treat-and-extend regimen was +8.8 (95% confidence interval [CI]: 5.8 to 11.8), +6.7 (95% CI: 3.2 to 10.1), and +5.4 (95% CI: -4.1 to 14.9) Early Treatment Diabetic Retinopathy Study (ETDRS) letters at 1 year (n = 1,539), 2 years (n = 2,521), and ≥3 years (n = 1,298), in comparison with +3.5 (95% CI: 2.0 to 5.0), +1.3 (95% CI: -1.6 to 4.2), and -1.9 (95% CI: -9.8 to 6.0) ETDRS letters for pro re nata at 1 year (n = 20,247), 2 years (n = 14,408), and ≥3 years (n = 11,714). Treat-and-extend patients received on average more injections (6.9 vs. 4.7) but had fewer visits (7.6 vs. 9.2) in the first year. Baseline characteristics were similar between the regimens. The reported rate of endophthalmitis was 17 of 66,176 intravitreal injections (0.026%).
  
  
  CONCLUSIONS
  Intravitreal ranibizumab for nAMD prevents severe visual loss in real-world practice. Patients can achieve visual gain from baseline, but the extent to which these are maintained in the long term may depend on the frequency of injections.
authors.affiliation: *Macula Research Group, Save Sight and Eye Health Institute, Sydney Medical School, University of Sydney, Sydney, Australia; †Ophthalmology Department, Royal Free London NHS Foundation Trust, London, United Kingdom; and ‡Department of Ophthalmology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
authors.forename: Leah N
authors.initials: LN
authors.lastname: Kim
authors.forename: Hemal
authors.initials: H
authors.lastname: Mehta
authors.forename: Daniel
authors.initials: D
authors.lastname: Barthelmes
authors.forename: Vuong
authors.initials: V
authors.lastname: Nguyen
authors.forename: Mark C
authors.initials: MC
authors.lastname: Gillies
mesh_terms: D000368:Aged; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D017326:Clinical Trials, Phase III as Topic; D005260:Female; D005451:Fluorescein Angiography; D005500:Follow-Up Studies; D006801:Humans; D058449:Intravitreal Injections; D008297:Male; D000069579:Ranibizumab / Q000627:therapeutic use*; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014792:Visual Acuity / Q000502:physiology; D057135:Wet Macular Degeneration / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology
chemical_list: D020533:Angiogenesis Inhibitors; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D000069579:Ranibizumab