Five-year results of intravitreal injections of anti-VEGF (ranibizumab) in real life with PRN regimen for exudative age-related macular degeneration: ELOUAN study

Abstract

Purpose: In this study we aimed to describe visual acuity (VA) evolution and assess the benefit of personalized monitoring in a population of patients treated in real life for wet age-related macular degeneration (AMD) with ranibizumab intravitreal injections (IVI) using pro re nata (PRN) regimen for 5 years. Methods:All consecutive patients treated in the ophthalmologic department from August 2011 to August 2013 were retrospectively enrolled.All patients had PRN monthly monitoring, either during AMD-dedicated or standard consultations.The primary objective was to study VA evolution, assessed by ETDRS and Snellen equivalent, over time.The secondary objectives were to assess the role of the following parameters on VA evolution: Follow-up (FU) and IVI visit numbers, treatment adherence (or delay between FU and IVI), neo-vessel (NV) types, induction phase or not, AMD-dedicated or standard consultation and to identify predictive factors for VA change.VA evolution and monitoring quality (FU number, IVI visit number) were analyzed up to 5 years.Results: Two-year analysis (n=144 patients): VA increased significantly between baseline and 6 months (p=0.0009 and p=0.0069). Induction phase did not significantly affect VA evolution (except at 6 months). Patients with induction phase had 3.5-times less chance of VA increase (p=0.0050). The initial NV type did not affect AV evolution. The ETDRS scores at 4, 6, 8 and 12 months were significantly higher with AMD-dedicated vs standard consultations (p<0.05).Five-year analysis (n=109 patients): VA declined, but not significantly, from 24 months until the end of the studied period. The mean number of FU and IV visits constantly decreased (mostly significantly).Conclusions: Systematic induction phase did not offer better prognosis. PRN monitoring with AMD-dedicated consultations seemed necessary during the first year, avoiding over-or undertreatment, often deleterious. These 5-year results in real life showed AV stabilization despite a significant decrease of FU and IVI visits over time.