Effectiveness of ranibizumab for neovascular age-related macular degeneration using clinician-determined retreatment strategy

Kumar, Amitabh; Sahni, Jayashree; Stangos, Alexandros N.; Campa, Claudio; Harding, Simon

doi:10.1136/bjo.2009.171868

Cited by 33 publications

(21 citation statements)

References 16 publications

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“…In relation to our observations, a clinical study by Kumar et al reported the mean number of intravitreal ranibizumab treatment 5.6±2.3 in 81 patients with neovascular AMD with similar treatment protocol to the PrONTO study [16]. Frequency of predominantly classic lesions in this study was only 22%; 17.1% of all patients gained 15 letters or more (in our study 32% of patients achieved a significant VA improvement).…”

Section: Discussionsupporting

confidence: 79%

“…We noted mean correlations between baseline average CRT and baseline average VA measured in ETDRS letters (p=0.017) and in logMAR scale (p=0.033) and between average CRT after the third injection and average VA in logMAR scale after the third injection (p=0.047). Kumar et al did not observe statistically significant correlations between CRT and VA, finding only a slight increase in the number of patients with CRT over 200 μm at the 9-month visit corresponding to the drop in vision [16]. In the PrONTO study, statistically significant correlations were found between the OCT-CRT measurements and VA at months 2, 3 and 12 [12].…”

Section: Discussionmentioning

confidence: 99%

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Effectiveness of ranibizumab intravitreal injections for exudative age-related macular degeneration treatment: 12-month outcomes

Figurska

Stankiewicz

2011

Med Sci Monit

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SummaryBackgroundThe aim of this paper was to evaluate functional and anatomical results of intravitreal ranibizumab injections and the course of exudative age-related macular degeneration (AMD) treatment over a 12-month observation period.Material/MethodsIn 25 patients with active dominantly classic exudative AMD, treatment was performed according to the following schedule: 3 intravitreal injections of 0.5 mg ranibizumab at monthly intervals (saturation phase); further injections were based on activity of the neovascular process. Changes in VA and central retinal thickness (CRT) during treatment were evaluated with ANOVA testing.ResultsMean pre-treatment best corrected visual acuity was 0.73±0.27 logMAR. After the third ranibizumab injection the best results, 0.54±0.27 logMAR, were seen; 12-month results were 0.58±0.26 logMAR. Patients had a mean improvement of 10.6 letters at 12 months. In 92% of patients stabilization or improvement of vision was observed. The mean number of injections in the 12-month period was 6.Baseline mean CRT was 351.12±74.15 μm. After the first ranibizumab injection it decreased significantly to 221.96±60.85 μm, after the third injection it was 200.80±47.63 μm, and after 12 months it was 213.16±44.37 μm. Mean correlations between baseline average CRT and baseline average VA measured in ETDRS letters (p=0.017) and in logMAR scale (p=0.033) and between average CRT after the third injection and average VA in logMAR scale after the third injection (p=0.047) were noted.ConclusionsTreatment with intravitreal ranibizumab injections according to the presented scheme provides AMD patients with a chance of stabilization and improvement of the topical state, with a lower number of injections and preserved topical and general safety. Our results suggest that regular monthly controls are necessary to be able react rapidly to the smallest signs of deterioration, not only in visual acuity, but also in OCT images.

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Section: Discussionsupporting

confidence: 79%

Section: Discussionmentioning

confidence: 99%

Effectiveness of ranibizumab intravitreal injections for exudative age-related macular degeneration treatment: 12-month outcomes

Figurska

Stankiewicz

2011

Med Sci Monit

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“…Within the current literature, there is a paucity of 'real-world' data with regard to outcomes of ranibizumab treatment for nAMD, and previous reports are often on small cohorts of patients despite originating from major institutions. [6][7][8][9][10][11][12][13][14][15][16] Few centres have emulated the mean VA gains of the ANCHOR and MARINA trials on unselected cohorts of patients. Table 3 compares the results in this study with that of the pivotal trials and pro re nata (PRN), and treat and extend reports demonstrating comparative mean VA at baseline and at 1 year.…”

Section: Discussionmentioning

confidence: 99%

“…[6][7][8][9][10][11][12][13][14][15][16] The aims of this paper are to establish VA outcomes and number of injections required each year for eyes with different baseline VA in a large cohort of treatment-naive patients in a real-world clinical setting. In addition, we wish to establish which measures of VA are the best measures of the quality of a service.…”

Section: Introductionmentioning

confidence: 99%

Which visual acuity measurements define high-quality care for patients with neovascular age-related macular degeneration treated with ranibizumab?

Ross

Donachie

Sallam

et al. 2012

Eye

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Purpose The purpose of this study is to define which visual acuity (VA) measurements are the best indicators of highquality care for patients receiving intravitreal ranibizumab for neovascular age-related macular degeneration (nAMD). Methods Analysis of prospectively collected data recorded within an electronic medical record system on treatment-naive, firsteligible eyes with nAMD, treated with ranibizumab using an as-needed treatment regimen with a minimum follow-up of 1 year. Data collection included the following: age, gender, laterality, type of nAMD, VA, central 1 mm OCT retinal thickness, number of intravitreal injections, and number of follow-up assessments. Results Data were available on the firsttreated eye from 406 patients with at least 1 year follow-up; of these, 198 had data at 2 years. The mean baseline VA of 54.4 Early Treatment Diabetic Retinopathy Study letters improved to 58.5 letters at 12 months and to 56.8 letters at 24 months. The mean VA changes from baseline to 1 year were þ 6.5, þ 7.5, þ 1.7, and À 1.5 letters, respectively, for baseline VA categories of 23-35, 36-55, 56-70, and 470 letters. Change in mean VA from the end of the loading phase to year 1 ranged from À 2.9 to þ 1.4 letters for the different baseline VA categories. The mean number of injections were similar across baseline VA categories ranging from 5.7 to 6.0 injections in year 1 and from 3.3 to 3.8 in year 2.Conclusions This large, real-world series demonstrates that mean change in VA is largely a function of selection criteria and baseline VA. The quality of a service is therefore better judged by actual VA outcomes and maintenance of vision after the loading phase.

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“…Therefore, different treatment regimens have been investigated to maintain efficacy with a reduced number of injections or visits 5–7. Studies published to date have used ophthalmoscopy, VA, and optical coherence tomography (OCT) criteria to guide retreatment but have failed to show improved effectiveness with regimen changes 8…”

Section: Introductionmentioning

confidence: 99%

Testing the clinical value of multifocal electroretinography and microperimetry and the effects of intravitreal therapy with ranibizumab on macular function in the course of wet age-related macular degeneration: a 1-year prospective study

Reinsberg¹,

Hilgers²,

Lüdeke³

et al. 2017

OPTH

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PurposeTo investigate the clinical value of multifocal electroretinography (mfERG) and microperimetry and the effects of intravitreal therapy with ranibizumab (Lucentis®) on macular function in the course of neovascular age-related macular degeneration (nAMD).Materials and methodsWe conducted a prospective single-arm interventional cohort study with 20 nAMD patients older than 50 years. Examinations were scheduled monthly for 1 year during intravitreal therapy with ranibizumab. The examinations included mfERG, microperimetry, spectral domain optical coherence tomography, and best-corrected visual acuity using ETDRS score.ResultsDuring the 12-month observation period, a significant positive linear correlation between the logarithm of minimum angle of resolution (logMAR) and scotoma area (r=0.28, 95% confidence interval [CI] 0.21–0.35), between logMAR and fovea thickness in optical coherence tomography (r=0.11, 95% CI 0.04–0.2), and a significant negative correlation between logMAR and mfERG (−0.37, 95% CI −0.43 to −0.31) were observed. A significant ranibizumab effect on logMAR was found (P=0.0065). From a total of 25 relapses, 14 were able to be predicted correctly by mfERG P1 decrease in the preceding month. However, there was no statistically significant relation between prediction and observed relapses (Fisher’s exact test, P=0.6726).ConclusionOur results indicate a possible role of mfERG and microperimetry in the monitoring of macular function and prediction of recurrence during intravitreal pharmacotherapy in wet AMD.

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Effectiveness of ranibizumab for neovascular age-related macular degeneration using clinician-determined retreatment strategy

Cited by 33 publications

References 16 publications

Effectiveness of ranibizumab intravitreal injections for exudative age-related macular degeneration treatment: 12-month outcomes

Effectiveness of ranibizumab intravitreal injections for exudative age-related macular degeneration treatment: 12-month outcomes

Which visual acuity measurements define high-quality care for patients with neovascular age-related macular degeneration treated with ranibizumab?

Testing the clinical value of multifocal electroretinography and microperimetry and the effects of intravitreal therapy with ranibizumab on macular function in the course of wet age-related macular degeneration: a 1-year prospective study

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