Comparison of the Effectiveness and Prognostic Factors of Intravitreal Ranibizumab between Typical Neovascular Age-Related Macular Degeneration and Polypoidal Choroidal Vasculopathy over 24 Months of Follow-Up

Abstract

Purpose: To compare the response to ranibizumab between patients with typical neovascular age-related macular degeneration (tAMD) and those with polypoidal choroidal vasculopathy (PCV), and to determine the predictors for the outcomes. Methods: Fifty-nine eyes from 59 consecutive patients (tAMD: 27 eyes, PCV: 32 eyes) were treated with three monthly ranibizumab injections followed by as-needed retreatment. Best-corrected visual acuity (BCVA) and morphological parameters were evaluated over 24 months of follow-up. Results: The mean BCVA in tAMD and PCV patients was significantly improved at 3 months (-0.22 and -0.09 logMAR units, respectively). The improvement in BCVA was sustained up to 24 months in tAMD (p = 0.01) but not in PCV patients. The significant predictor for good response to ranibizumab in tAMD patients was the improvement of BCVA at 3 months, whereas that in PCV patients was the anatomical resolution at 3 months. Conclusions: Ranibizumab is an effective therapy for tAMD and PCV over 24 months. The predictors for good outcome might be different between tAMD and PCV.

Epidemiological and Clinical Baseline Characteristics as Predictive Biomarkers of Response to Anti-VEGF Treatment in Patients with Neovascular AMD

“…Retrospective analysis of medical records from patients with nAMD treated with ranibizumab supports these phase 3 data, with a Pearson correlation test identifying increasing age as significantly associated with a worse visual prognosis at month 12 for patients with nAMD ( p = 0.02), but interestingly not those with polypoidal choroidal vasculopathy (PCV; p > 0.22) [ 21 ]. However, a separate retrospective interventional cohort study of ranibizumab treatment showed an association between age and response at month 24 in patients with PCV ( p = 0.03), but not those with nAMD ( p = 0.87) using univariate logistic analyses [ 22 ]. Age at baseline was also identified as a predictor of VA response at 3 to 12 months in retrospective analyses of patients receiving bevacizumab [ 23 – 25 ] and ranibizumab [ 26 ].…”

Evaluation of Abicipar Pegol (an Anti-VEGF DARPin Therapeutic) in Patients With Neovascular Age-Related Macular Degeneration: Studies in Japan and the United States

“…25 Although ranibizumab, bevacizumab, and aflibercept have all demonstrated efficacy in improving vision, decreasing foveal thickness, and causing polyp regression in patients with PCV, [26][27][28] ranibizumab therapy may be more effective in eyes with typical nAMD than in eyes with PCV. 8 In the BAMBOO study, abicipar had beneficial effects on BCVA and CRT in both patients with PCV and patients with typical nAMD.…”

“…Moreover, subtypes of nAMD that have been identified (typical nAMD, polypoidal choroidal vasculopathy [PCV], and retinal angiomatous proliferation) appear to differ in their responsiveness to anti-VEGF treatment. [7][8][9] In a cross-sectional, retrospective study, most patients diagnosed with nAMD who demonstrated a poor response to ranibizumab had atypical nAMD, with the majority having PCV. 10 These results suggest a need for novel treatments for nAMD that require less-frequent administration (decreasing the burden of treatment) and that are effective in atypical subtypes of nAMD lesions.…”

Comparison of the 12-Month Outcomes of Intravitreal Ranibizumab between Two Angiographic Subtypes of Polypoidal Choroidal Vasculopathy

“…Previous reports have demonstrated that PCV showed a good visual outcome with IVR [6,7,18] , but it is also known that certain PCV cases exhibited poor response to IVR [10,19] although the reasons were unknown. In the present study, type 1 PCV classified by the presence of clear BVN with polypoidal lesions showed a good visual outcome of IVR, but type 2 PCV did not show any improvement in mean BCVA.…”