Ranibizumab Treatment for Neovascular AMD
Ranibizumab Treatment for Neovascular AMD
A total of 165 eyes of 165 patients were enrolled in this study, of which 98 patients were female. Patient age ranged from 56 to 94 years (mean 78 years). All of the patients completed the six-month follow-up. No major ocular or systemic adverse events were observed in the follow-up period.
The lesions were classified as occult with no classic CNV in 86 eyes (52.1%), minimally classic CNV in 18 eyes (10.9%), predominantly classic CNV in 38 eyes (23%) and RAP lesions in the remaining 23 eyes (13.9%); see Figure 1. At baseline, 20 eyes (12.1%) presented a pigment epithelium detachment. The lesion location was subfoveal in 130 eyes (78.8%), parafoveal in 26 eyes (15.8%), and extrafoveal in 9 eyes (5.5%).
(Enlarge Image)
Figure 1.
Proportion of reduced responders (black) and responders (white) in the various CNV types (occult, minimally classic, predominantly classic and RAP). The type of lesion was not related to the risk of a reduced response to treatment.
During the six-month follow-up, the majority of eyes (135 eyes, 81.8%) received the three consecutive injections in the first three months of treatment and needed no retreatment during follow-up, while 29 eyes (17.6%) received four injections and in one eye (0.6%), five injections of ranibizumab.
At baseline, the mean logMAR BCVA was 0.70 ± 0.30 (mean ± SD); the mean visual acuity improved to 0.55 ± 0.30 after the three consecutive injections and was 0.62 ± 0.33 at the end of follow-up; see Figure 2.
(Enlarge Image)
Figure 2.
Change in mean visual acuity (LogMar) of reduced responders (black) and responders (white) at baseline (month 0) to the end of follow-up (month 6).
The initial foveal thickness was 339 ± 84 μm (mean ± SD). After the three monthly consecutive injections of ranibizumab, this value decreased to 234 ± 59 μm and measured 280 ± 89 μm at the end of follow-up; see Figure 3.
(Enlarge Image)
Figure 3.
Change in mean retinal thickness (μm) of reduced responders (black) and responders (white) at baseline (month 0) and after the first three consecutive injections (month 4) to the end of follow-up (month 6).
At baseline, the mean CNV size (GLD, greatest linear dimension) was 1736 ± 1093 μm (mean ± SD) initially; 338 ± 777 μm, after the first three injections; and 750 ± 885 μm, at the end of follow-up; see Figure 4.
(Enlarge Image)
Figure 4.
Change in the mean CNV size (μm) of reduced responders (black) and responders (white) at baseline (month 0) and after the first three consecutive injections (month 4), until the end of follow-up (month 6).
One patient (0.6%) had lost three or more lines of vision at the end of follow-up, while 29 patients (17.6%) had gained three or more lines at the end of follow-up compared to baseline.
According to the criteria listed above, 58 out of 165 eyes (35.2%) were considered to be reduced responders to the treatment at the end of follow-up, presenting either a reduction in visual acuity compared to baseline and/or persistent intraretinal or subretinal fluid or persistent or recurrent choroidal neovascularisation.
We related the initial CNV size at baseline to the risk of being a reduced responder at the end of follow-up; see Figure 1. The OR (odds ratio) was 0.964 per 100 μm increase of the initial CNV size (GLD) (95% CI, 0.936–0.993, p = 0.017); see Table 1.
Table 1 shows that none of the initial presence of a pigment epithelium detachment (OR 1.728, 95% CI, 0.595–5.024, p = 0.315), the central retinal thickness at baseline (OR 0.998, 95% CI, 0.994–1.002, p = 0.362), the lesion type (OR 0.887, 0.966, 1.597 for minimally classic, predominantly classic, RAP vs. occult, p = 0.820, p = 0.932, p = 0.373, respectively), the patient age (OR 0.986, 95% CI, 0.943–1.030, p = 0.513), or the time between the first patient consultation and the first injection (OR 0.995, 95% CI, 0.981–1.009, p = 0.425) were related to the likelihood of a reduced response to treatment.
Results
A total of 165 eyes of 165 patients were enrolled in this study, of which 98 patients were female. Patient age ranged from 56 to 94 years (mean 78 years). All of the patients completed the six-month follow-up. No major ocular or systemic adverse events were observed in the follow-up period.
The lesions were classified as occult with no classic CNV in 86 eyes (52.1%), minimally classic CNV in 18 eyes (10.9%), predominantly classic CNV in 38 eyes (23%) and RAP lesions in the remaining 23 eyes (13.9%); see Figure 1. At baseline, 20 eyes (12.1%) presented a pigment epithelium detachment. The lesion location was subfoveal in 130 eyes (78.8%), parafoveal in 26 eyes (15.8%), and extrafoveal in 9 eyes (5.5%).
(Enlarge Image)
Figure 1.
Proportion of reduced responders (black) and responders (white) in the various CNV types (occult, minimally classic, predominantly classic and RAP). The type of lesion was not related to the risk of a reduced response to treatment.
During the six-month follow-up, the majority of eyes (135 eyes, 81.8%) received the three consecutive injections in the first three months of treatment and needed no retreatment during follow-up, while 29 eyes (17.6%) received four injections and in one eye (0.6%), five injections of ranibizumab.
At baseline, the mean logMAR BCVA was 0.70 ± 0.30 (mean ± SD); the mean visual acuity improved to 0.55 ± 0.30 after the three consecutive injections and was 0.62 ± 0.33 at the end of follow-up; see Figure 2.
(Enlarge Image)
Figure 2.
Change in mean visual acuity (LogMar) of reduced responders (black) and responders (white) at baseline (month 0) to the end of follow-up (month 6).
The initial foveal thickness was 339 ± 84 μm (mean ± SD). After the three monthly consecutive injections of ranibizumab, this value decreased to 234 ± 59 μm and measured 280 ± 89 μm at the end of follow-up; see Figure 3.
(Enlarge Image)
Figure 3.
Change in mean retinal thickness (μm) of reduced responders (black) and responders (white) at baseline (month 0) and after the first three consecutive injections (month 4) to the end of follow-up (month 6).
At baseline, the mean CNV size (GLD, greatest linear dimension) was 1736 ± 1093 μm (mean ± SD) initially; 338 ± 777 μm, after the first three injections; and 750 ± 885 μm, at the end of follow-up; see Figure 4.
(Enlarge Image)
Figure 4.
Change in the mean CNV size (μm) of reduced responders (black) and responders (white) at baseline (month 0) and after the first three consecutive injections (month 4), until the end of follow-up (month 6).
One patient (0.6%) had lost three or more lines of vision at the end of follow-up, while 29 patients (17.6%) had gained three or more lines at the end of follow-up compared to baseline.
According to the criteria listed above, 58 out of 165 eyes (35.2%) were considered to be reduced responders to the treatment at the end of follow-up, presenting either a reduction in visual acuity compared to baseline and/or persistent intraretinal or subretinal fluid or persistent or recurrent choroidal neovascularisation.
We related the initial CNV size at baseline to the risk of being a reduced responder at the end of follow-up; see Figure 1. The OR (odds ratio) was 0.964 per 100 μm increase of the initial CNV size (GLD) (95% CI, 0.936–0.993, p = 0.017); see Table 1.
Table 1 shows that none of the initial presence of a pigment epithelium detachment (OR 1.728, 95% CI, 0.595–5.024, p = 0.315), the central retinal thickness at baseline (OR 0.998, 95% CI, 0.994–1.002, p = 0.362), the lesion type (OR 0.887, 0.966, 1.597 for minimally classic, predominantly classic, RAP vs. occult, p = 0.820, p = 0.932, p = 0.373, respectively), the patient age (OR 0.986, 95% CI, 0.943–1.030, p = 0.513), or the time between the first patient consultation and the first injection (OR 0.995, 95% CI, 0.981–1.009, p = 0.425) were related to the likelihood of a reduced response to treatment.
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