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Results of flexible ranibizumab treatment in age-related macular degeneration and search for parameters with impact on outcome

  • Retinal Disorders
  • Published:
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Abstract

Background

The aim of this study was to analyse functional results of flexible ranibizumab treatment in exudative age-related macular degeneration (AMD), and to search for parameters with impact on outcome.

Methods

Analysis of a retrospective institutional case series (104 eyes) with a low-threshold re-treatment algorithm and monthly follow-up for 12 months.

Results

Visual acuity (VA) improved at month 3 by +6.7 letters and declined slightly until month 12 to a level of +5.0 letters. On average, eyes received 5.8 injections. A significant loss in VA occurred in the whole group between months 5 and 6 (−2.0 letters), never in the “winner” group (improvement of >5 letters at month 12), between months 5 and 6 (−3.8 letters) in the “stabilizer” group (∆ of ±5 letters at month 12) and twice, between months 3 and 7 (−7.0 letters) and months 9 and 12 (−6.9 letters), in the “loser” group (loss of >5 letters at month 12). These major functional declines followed moderate but significant increases in average CFT (OCT-central foveal thickness) of 23 to 33 μm. Increased CFT followed periods with a low percentage of treated eyes per month in each group. The amount of regained vision was significantly related to the extent of previous functional loss. The critical limit of short-term VA decline that was associated with the possibility for full VA restoration can approximately be quantified at −4 letters. Restoration of short-term VA deterioration (last month) was significantly better than long-term VA loss (related to the end of loading phase). Restoration of VA loss stratifies mainly into two groups: a group that regained −25 to 25% and one that regained 75 to 125%. A significant correlation was found between the number of injections and functional outcome at month 12 for eyes receiving more than four injections. It was calculated that a mean of 8.4 injections per eye would have been necessary to stabilize vision within the first 12 months.

Conclusions

CFT is a sensitive and early predictor of VA deterioration. Four letters of acute VA loss seems to be a critical limit. VA loss of ≥4 letters appears to be associated with incomplete recovery. Eyes with <1 line of gain at the end of the loading phase should be considered for continuation of treatment at months 3 and 4. According to our calculations an average number of 8.4 injections/eye seems to be necessary to maintain stabilization of vision in the first year of treatment.

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Acknowledgements

The authors thank Prof. Dr. Daniel Pauleikhoff and Priv.-Doz. Dr. Andreas Wenzel for their cooperative contribution in discussing our data, Conny Meier for her skilful organization, and the Pallas Group AG for financing a fellowship of Dr. Loukopoulos.

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Authors and Affiliations

  1. Department of Retinology, Klinik Pallas, Louis-Giroud-Str. 20, CH-4600, Olten, Switzerland

    Heinrich Gerding, Vlassios Loukopoulos, Juliane Riese, Lars Hefner & Melanie Timmermann

  2. Department of Ophthalmology, University of Münster, Domagkstr. 15, 48129, Münster, Germany

    Heinrich Gerding

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  1. Heinrich Gerding
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  2. Vlassios Loukopoulos
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  3. Juliane Riese
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  4. Lars Hefner
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Corresponding author

Correspondence to Heinrich Gerding.

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Financial relationships

H.G. received lecture honoraria by Novartis. The authors do not have financial interests in products mentioned or alternative products.

The authors have full control of all primary data, and agree to allow Graefe`s Archive for Clinical and Experimental Ophthalmology to review their data upon request.

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Gerding, H., Loukopoulos, V., Riese, J. et al. Results of flexible ranibizumab treatment in age-related macular degeneration and search for parameters with impact on outcome. Graefes Arch Clin Exp Ophthalmol 249, 653–662 (2011). https://doi.org/10.1007/s00417-011-1636-6

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  • DOI: https://doi.org/10.1007/s00417-011-1636-6

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