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Published in: Graefe's Archive for Clinical and Experimental Ophthalmology 2/2013

01-02-2013 | Retinal Disorders

Long-term effects of ranibizumab treatment delay in neovascular age-related macular degeneration

Authors: Philipp S. Muether, Robert Hoerster, Manuel M. Hermann, Bernd Kirchhof, Sascha Fauser

Published in: Graefe's Archive for Clinical and Experimental Ophthalmology | Issue 2/2013

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Abstract

Background

Intravitreal injections of ranibizumab are the standard of care for neovascular age-related macular degeneration (AMD). In clinical trials, comparable efficacy has been shown for either monthly injections or as needed injections upon monthly controls. Unlike in trial settings, treatment in clinical routine is often delayed by complex approval procedures of health insurance and limited short-term surgical capacities.

Methods

Eighty-nine patients with neovascular AMD were followed for 12 months. Early treatment diabetic retinopathy study (ETDRS) visual acuity (VA), Radner reading VA and spectral domain optical coherence tomography were performed monthly, with additional fluorescein angiography if needed. After an initial loading phase of three consecutive monthly intravitreal injections with ranibizumab, re-injections were performed when recurrent activity of choroidal neovascularization (CNV) was detected.

Results

After an initial increase to a value of +5.0 ± 11.87 ETDRS letters from baseline, VA constantly decreased over 12 months to a value of −0.66 ± 16.82 ETDRS letters below baseline. Central retinal thickness (CRT) decreased from a value of 438.1 ± 191.4 μm at baseline to a value of 289.9 ± 138.6 μm after initial therapy and stabilized at a value of 322.4 ± 199.5 μm. Loss of VA during latency between indication to treat and treatment was significantly greater than re-gain of VA after re-initiation of therapy (−2.2 ± 5.0 versus 0.4 ± 7.4 letters; p = 0.046).

Conclusions

Latency between indication to treat and treatment is responsible for irreversible VA deterioration. A successful PRN treatment regimen for neovascular AMD requires immediate access to therapy after indication.
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Metadata
Title
Long-term effects of ranibizumab treatment delay in neovascular age-related macular degeneration
Authors
Philipp S. Muether
Robert Hoerster
Manuel M. Hermann
Bernd Kirchhof
Sascha Fauser
Publication date
01-02-2013
Publisher
Springer-Verlag
Published in
Graefe's Archive for Clinical and Experimental Ophthalmology / Issue 2/2013
Print ISSN: 0721-832X
Electronic ISSN: 1435-702X
DOI
https://doi.org/10.1007/s00417-012-2038-0

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