Abstract
A remarkable proportion of neovascular age-related macular degeneration (nAMD) patients respond rather poorly to ranibizumab treatment, in spite of the minimum 4-week follow-up and treatment interval. Usually, retreatments are based on nAMD activity as evaluated by Spectral-domain Optical coherence Tomography (SD-OCT), biomicroscopic fundus examination and visual acuity changes. In this prospective pilot study, we aimed to study SD-OCT changes in a high-frequent follow-up manner (weekly (month 0–6), biweekly (month 7–12)) throughout the first year, which consequently led to intravitreal ranibizumab being administered up to biweekly. Best corrected visual acuity (BCVA) was already significantly improved at week 2. Central retinal thickness (CRT), intraretinal and subretinal fluid (SRF) were significantly improved from week 1 onwards. Half of the patients showed nAMD activity at week 2 or 3 and received the first retreatment earlier than 4 weeks after baseline injection. In total, 46% of retreatments were already applied 2 or 3 weeks after the previous treatment. Greater range of CRT and SRF fluctuation during follow-up was associated with lower final BCVA. Lower baseline BCVA and better SRF improvement at week 2 was associated with greater BCVA improvement. In conclusion, high-frequency SD-OCT follow-up provided a good option for adapting treatment in nAMD individually.
Highlights
A remarkable proportion of neovascular age-related macular degeneration patients respond rather poorly to ranibizumab treatment, in spite of the minimum 4-week follow-up and treatment interval
In this prospective study we investigated a high-frequency Spectral-domain Optical coherence Tomography (SD-OCT) follow-up which could lead to early intravitreal ranibizumab retreatment in patients with neovascular age-related macular degeneration (nAMD)
In our study, during the entire follow-up period, due to activity on high-frequency SD-OCT follow-up 46% of all retreatments were already applied 2 to 3 weeks after the previous treatment and 65% of eyes showed at least once early/persisting activity on SD-OCT at week 2 or 3 after the last treatment. This seems to correspond with the findings from Comparison of AMD Treatment Trials (CATT) where the proportion of eyes without intra- and/or subretinal fluid was only 45.5% at the 2 year exit visit (4 weeks after the last ranibizumab injection)[24], meaning that more than half of patients showed fluid on OCT despite 4-week treatment intervals and at least a few of them could have fulfilled our early retreatment criteria
Summary
A remarkable proportion of neovascular age-related macular degeneration (nAMD) patients respond rather poorly to ranibizumab treatment, in spite of the minimum 4-week follow-up and treatment interval. Novais et al reported a daily SD-OCT follow-up performed during 30 days after the first bevacizumab injection[21] In this prospective, interventional study of 9 eyes, in approximately half of the patients the individual minimal central retinal thickness was found to be between day 14 and 17 with an increase of fluid a fterwards[21]. Interventional study of 9 eyes, in approximately half of the patients the individual minimal central retinal thickness was found to be between day 14 and 17 with an increase of fluid a fterwards[21] This supports the approach of biweekly injections if needed. This study was designed to evaluate SD-OCT changes in a high-frequent follow-up manner throughout the first year, which led to intravitreal ranibizumab retreatment being administered earlier than 4 weeks after the last treatment (up to biweekly) in nAMD. SD-OCT changes, efficacy and outcome predictors were determined; any safety issues were reported despite this pilot study not being powered for statistical safety analysis
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