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Graefe's Archive for Clinical and Experimental Ophthalmology

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01-08-2015 | Retinal Disorders

Refractory subretinal fluid in patients with neovascular age-related macular degeneration treated with intravitreal ranibizumab: visual acuity outcome

Authors: Liuna Jang, Christina Gianniou, Aude Ambresin, Irmela Mantel

Published in: Graefe's Archive for Clinical and Experimental Ophthalmology | Issue 8/2015

Abstract

Purpose

To investigate the functional outcome of eyes with neovascular AMD (nAMD) and subretinal fluid (SRF) refractory to treatment with ranibizumab.

Methods

Retrospective chart review of consecutive treatment-refractory SRF in nAMD despite monthly ranibizumab injections during 12 months or more. Data were evaluated for baseline characteristics, location of the refractory SRF, mean visual acuity (VA) change, number of injections, and timepoint of first complete disappearance of SRF.

Results

Forty-five eyes in 44 patients (mean age of 76 years) were included. The mean follow-up was 32.4 months (range 12–73 months). The mean number of injections was 11.6 in the first year and 27.5 over follow-up. The refractory SRF was located subfoveally in 66.7 %. In 12 eyes (26.7 %), complete absorption of SRF was found after a mean of 22.6 months (range, 13–41 months). Mean VA increased by 10.4, 8.2, and 8.6 letters by month 12, 24, and 36, respectively.

Conclusions

Neovascular AMD with SRF refractory to monthly retreatment with ranibizumab may still allow good and maintained visual improvement, even if the fluid is located subfoveally. SRF may progressively absorb under continuous monthly treatment. The necessity to treat refractory SRF with monthly injections could be questioned and would need future investigations.

Boyer DS, Antoszyk AN, Awh CC, Bhisitkul RB, Shapiro H, Acharya NR, MARINA Study Group (2007) Subgroup analysis of the MARINA study of ranibizumab in neovascular age-related macular degeneration. Ophthalmol 114:246–252CrossRef

Kaiser PK, Brown DM, Zhang K, Hudson HL, Holz FG, Shapiro H, Schneider S, Acharya NR (2007) Ranibizumab for predominantly classic neovascular age-related macular degeneration: subgroup analysis of first-year ANCHOR results. Am J Ophthalmol 144:850–857PubMedCrossRef

Lalwani GA, Rosenfeld PJ, Fung AE, Dubovy SR, Michels S, Feuer W, Davis JL, Flynn HW Jr, Esquiabro M (2009) A variable-dosing regimen with intravitreal ranibizumab for neovascular age-related macular degeneration: year 2 of the PrONTO Study. Am J Ophthalmol 148:43–58PubMedCrossRef

Martin DF, Maguire MG, Fine SL, Ying G, Jaffe GJ, Grunwald JE, Toth C, Redford M, Ferris FL (2012) Ranibizumab and bevacizumab for treatment of neovascular age-related macular degeneration: two-year results. Ophthalmol 119:1388–1398CrossRef

Chakravarthy U, Harding SP, Rogers CA, Downes SM, Lotery AJ, Culliford LA, Reeves BC, IVAN study investigators (2013) Alternative treatments to inhibit VEGF in age-related choroidal neovascularisation: 2-year findings of the IVAN randomised controlled trial. Lancet 382:1258–1267PubMedCrossRef

Busbee BG, Ho AC, Brown DM, Heier JS, Suñer IJ, Li Z, Rubio RG, Pf L (2013) Twelve-month efficacy and safety of 0.5 mg or 2.0 mg ranibizumab in patients with subfoveal neovascular age-related macular degeneration. Ophthalmol 120:1046–1056CrossRef

Schmidt-Erfurth U, Eldem B, Guymer R, Korobelnik JF, Schlingemann RO, Axer-Siegel R, Wiedemann P, Simader C, Gekkieva M, Weichselberger A, EXCITE Study Group (2011) Efficacy and safety of monthly versus quarterly ranibizumab treatment in neovascular age-related macular degeneration: the EXCITE study. Ophthalmol 118:831–839CrossRef

Abraham P, Yue H, Wilson L (2010) Randomized, double-masked, sham-controlled trial of ranibizumab for neovascular age-related macular degeneration: PIER study year 2. Am J Ophthalmol 150:315–324PubMedCrossRef

Holz FG, Amoaku W, Donate J, Guymer RH, Kellner U, Schlingemann RO, Weichselberger A, Staurenghi G, SUSTAIN Study Group (2011) Safety and efficacy of a flexible dosing regimen of ranibizumab in neovascular age-related macular degeneration: the SUSTAIN study. Ophthalmol 118:663–671CrossRef

10.

Dadgostar H, Ventura AACM, Chung JY, Sharma S, Kaiser PK (2009) Evaluation of injection frequency and visual acuity outcomes for ranibizumab monotherapy in exudative age-related macular degeneration. Ophthalmol 116:1740–1747CrossRef

11.

Rosenfeld Philip J, Shapiro H, Tuomi L, Webster M, Elledge J, Blodi B, MARINA and ANCHOR Study Groups (2011) Characteristics of patients losing vision after 2 years of monthly dosing in the phase III ranibizumab clinical trials. Ophthalmol 118:523–530CrossRef

12.

Martin DF, Maguire MG, Ying GS, Grunwald JE, Fine SL, Jaffe GJ (2011) Ranibizumab and bevacizumab for neovascular age-related macular degeneration. CATT research group. N Engl J Med 364:1897–908PubMedCrossRef

13.

Gupta OP, Shienbaum G, Patel AH, Fecarotta C, Kaiser RS, Regillo CD (2010) A treat and extend regimen using ranibizumab for neovascular age-related macular degeneration clinical and economic impact. Ophthalmol 117:2134–40CrossRef

14.

Mantel I, Zografos L, Ambresin A (2008) Early clinical experience with ranibizumab for occult and minimally classic neovascular membranes in age-related macular degeneration. Ophthalmol 222:321–3CrossRef

15.

Mitchell P, Korobelnik JF, Lanzetta P, Holz FG, Prünta C, Schmidt-Erfurth U, Tano Y, Wolf S (2010) Ranibizumab (Lucentis) in neovascular age-related macular degeneration: evidence from clinical trials. Br J Ophthalmol 94:2–13PubMedCrossRef

16.

Finger RP, Wiedemann P, Blumhagen F, Pohl K, Holz FG (2013) Treatment patterns, visual acuity and quality-of-life outcomes of the WAVE study—a noninterventional study of ranibizumab treatment for neovascular age-related macular degeneration in Germany. Acta Ophthalmol 91:540–6PubMedCrossRef

17.

Tschuor P, Pilly B, Venugopal D, Gale RP (2013) Optimising assessment intervals improves visual outcomes in ranibizumab-treated age-related neovascular degeneration: using the stability phase as a benchmark. Graefes Arch Clin Exp Ophthalmol 251:2327–30PubMedCrossRef

18.

Gerding H (2010) Treatment of wet AMD with less than 12 injections of ranibizumab per year. Klin Monbl Augenheilkd 227:284–7

19.

Ersoy L, Ristau T, Kirchhof B, Liakopoulos S (2013) Response to anti-VEGF therapy in patients with subretinal fluid and pigment epithelial detachment on spectral-domain optical Cohen tomography. Graefes Arch Clin Exp OphthalmolThis is Graefes Arch Clin Exp Ophthalmol (2014) Jun 252(6):889–97

20.

Konstantinidis L, Mantel I, Zografos L, Ambresin A (2010) Intravitreal ranibizumab in the treatment of choroidal neovascularization associated with idiopathic central serous chorioretinopathy. Eur J Ophthalmol 20:955–8PubMed

21.

Roisman L, Ribeiro JC, Fechine FV, Lavinsky D, Moraes N, Campos M, Farah ME (2014) Does microperimetry have a prognostic value in central serous chorioretinopathy? Retina. 34(4):713–8

22.

Fassnacht-Riederle H, Becker M, Graf N, Michel S (2014) Effect of aflibercept in insufficient responders to prior anti-VEGF therapy in neovascular AMD. Graefes Arch Clin Exp Ophthalmol Graefes Arch Clin Exp Ophthalmol. doi:10.1007/s00417-014-2589-3

23.

Yonekawa Y, Andreoli C, Miller JB, Loewenstein JI, Sobrin L, Eliott D, Vavvas DG, Miller JW, Kim IK (2013) Conversion to aflibercept for chronic refractory or recurrent neovascular age-related macular degeneration. Am J Ophthalmol 156:29–35PubMedCrossRef

24.

Cho H, Shah CP, Weber M, Heier JS (2013) Aflibercept for exudative AMD with persistent fluid on ranibizumab and/or bevacizumab. Br J Ophthalmol 97:1032–5PubMedCrossRef

25.

Bakall B, Folk JC, Boldt HC, Sohn EH, Stone EM, Russell SR, Mahajan VB (2013) Aflibercept therapy for exudative age-related macular degeneration resistant to bevacizumab and ranibizumab. Am J Ophthalmol 156:15–22PubMedCrossRef

Title: Refractory subretinal fluid in patients with neovascular age-related macular degeneration treated with intravitreal ranibizumab: visual acuity outcome
Authors: Liuna Jang
Christina Gianniou
Aude Ambresin
Irmela Mantel
Publication date: 01-08-2015
Publisher: Springer Berlin Heidelberg
Published in: Graefe's Archive for Clinical and Experimental Ophthalmology / Issue 8/2015
Print ISSN: 0721-832X
Electronic ISSN: 1435-702X
DOI: https://doi.org/10.1007/s00417-014-2789-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Refractory subretinal fluid in patients with neovascular age-related macular degeneration treated with intravitreal ranibizumab: visual acuity outcome

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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