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

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• 作者：Philipp S. Muether (1)
  Robert Hoerster (1)
  Manuel M. Hermann (1)
  Bernd Kirchhof (1)
  Sascha Fauser (1)
  
• 关键词：Exudative age ; related macular degeneration ; Treatment delay ; Spectral domain optical coherence tomography ; Ranibizumab ; Visual acuity ; Central retinal thickness ; Choroidal neovascularization
• 刊名：Graefe's Archive for Clinical and Experimental Ophthalmology
• 出版年：2013
• 出版时间：February 2013
• 年：2013
• 卷：251
• 期：2
• 页码：453-458
• 全文大小：218KB
• 参考文献：1. Rosenfeld PJ, Brown DM, Heier JS, Boyer DS, Kaiser PK, Chung CY, Kim RY (2006) Ranibizumab for neovascular age-related macular degeneration. N Engl J Med 355:1419-431 CrossRef
  2. Regillo CD, Brown DM, Abraham P, Yue H, Ianchulev T, Schneider S, Shams N (2008) Randomized, double-masked, sham-controlled trial of ranibizumab for neovascular age-related macular degeneration: PIER Study year 1. Am J Ophthalmol 145:239-48 CrossRef
  3. Martin DF, Maguire MG, Ying GS, Grunwald JE, Fine SL, Jaffe GJ (2011) Ranibizumab and bevacizumab for neovascular age-related macular degeneration. N Engl J Med 364:1897-908 CrossRef
  4. Muether PS, Hermann MM, Koch K, Fauser S (2011) Delay between medical indication to anti-VEGF treatment in age-related macular degeneration can result in a loss of visual acuity. Graefes Arch Clin Exp Ophthalmol 249:633-37 CrossRef
  5. Bashshur ZF, Haddad ZA, Schakal AR, Jaafar RF, Saad A, Noureddin BN (2009) Intravitreal bevacizumab for treatment of neovascular age-related macular degeneration: the second year of a prospective study. Am J Ophthalmol 148:59-5 CrossRef
  6. Lalwani GA, Rosenfeld PJ, Fung AE, Dubovy SR, Michels S, Feuer W, Davis JL, Flynn HW Jr, Esquiabro M (2009) A variable-dosing regimen with intravitreal ranibizumab for neovascular age-related macular degeneration: year 2 of the PrONTO Study. Am J Ophthalmol 148:43-8 CrossRef
  7. Keane PA, Liakopoulos S, Chang KT, Wang M, Dustin L, Walsh AC, Sadda SR (2008) Relationship between optical coherence tomography retinal parameters and visual acuity in neovascular age-related macular degeneration. Ophthalmology 115:2206-214 CrossRef
  8. Heimes B, Lommatzsch A, Zeimer M, Gutfleisch M, Spital G, Dietzel M, Pauleikhoff D (2011) Long-term visual course after anti-VEGF therapy for exudative AMD in clinical practice evaluation of the German reinjection scheme. Graefes Arch Clin Exp Ophthalmol 249:639-44. doi:10.1007/s00417-010-1524-5 CrossRef
  9. Gerding H, Loukopoulos V, Riese J, Hefner L, Timmermann M (2011) Results of flexible ranibizumab treatment in age-related macular degeneration and search for parameters with impact on outcome. Graefes Arch Clin Exp Ophthalmol 249:653-62 CrossRef
  
• 作者单位：Philipp S. Muether (1)
  Robert Hoerster (1)
  Manuel M. Hermann (1)
  Bernd Kirchhof (1)
  Sascha Fauser (1)
  
  1. Department of Vitreoretinal Surgery, Center of Ophthalmology, University of Cologne, Kerpener Strasse 62, 50924, Cologne, Germany
  
• ISSN：1435-702X

文摘

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?±-1.87 ETDRS letters from baseline, VA constantly decreased over 12?months to a value of ?.66?±-6.82 ETDRS letters below baseline. Central retinal thickness (CRT) decreased from a value of 438.1?±-91.4?μm at baseline to a value of 289.9?±-38.6?μm after initial therapy and stabilized at a value of 322.4?±-99.5?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?±-.0 versus 0.4?±-.4 letters; p--.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.