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

  • Retinal Disorders
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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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Acknowledgments

This study was supported by the Koeln Fortune Program, Faculty of Medicine, University of Cologne. The authors thank Susanne Nelles for database maintenance.

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Authors and Affiliations

  1. Department of Vitreoretinal Surgery, Center of Ophthalmology, University of Cologne, Kerpener Strasse 62, 50924, Cologne, Germany

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

Authors
  1. Philipp S. Muether
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  2. Robert Hoerster
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  3. Manuel M. Hermann
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  4. Bernd Kirchhof
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  5. Sascha Fauser
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Corresponding author

Correspondence to Philipp S. Muether.

Additional information

Supported by the Koeln Fortune Program, Faculty of Medicine, University of Cologne

Financial relation: Bernd Kirchhof and Sascha Fauser have a consultant and advisory board relationship with Novartis Pharma, Nuernberg, Germany outside the submitted work.

Registered at ClinicalTrials.gov identifier: NCT01213667.

Authors have full control of all primary data and agree to allow Graefes Archive for Clinical and Experimental Ophthalmology to review the data on request.

Registered at ClinicalTrials.gov identifier: NCT01213667.

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Muether, P.S., Hoerster, R., Hermann, M.M. et al. Long-term effects of ranibizumab treatment delay in neovascular age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol 251, 453–458 (2013). https://doi.org/10.1007/s00417-012-2038-0

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  • DOI: https://doi.org/10.1007/s00417-012-2038-0

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