Abstract
BackgroundTo investigate the third-year results of ranibizumab monotherapy for polypoidal choroidal vasculopathy (PCV) in individualized treatment regimens based on the outcomes during 2 years.MethodsOne hundred seventy-two consecutive eyes of 163 prospective treatment-naïve patients with PCV were treated with three monthly intravitreal ranibizumab injections followed by as-needed reinjections and completed a 2-year follow-up. Treatment regimens during the third year were selected individually based on their outcomes from the following treatment regimens: as-needed injections based on quarterly examinations, as-needed injections based on monthly examinations, a monthly ranibizumab injection schedule, and the treat-and-extend schedule. Visual acuity (VA) and foveal thickness at the end of the third year and the prevalence of discontinuous follow-up examinations during the third year were evaluated.ResultsOf 163 patients, 35 (21%) patients were excluded; nine patients had discontinuous follow-up examinations during the third year. In 128 eyes of 128 patients studied during the third year, the significant improvements in VA and foveal thickness 2 years after the first injection compared to baseline were maintained at the end of the third year. Six (18%, 6/34) patients treated with as-needed injections based on quarterly examinations had discontinuous follow-up examinations, the prevalence of which differed significantly (P = 0.025) from the other groups.ConclusionsThe individualized treatment strategies in the third year based on each patient’s outcomes during 2 years maintained the improved VA and avoided discontinuation of follow-up during the third year.
Highlights
To investigate the third-year results of ranibizumab monotherapy for polypoidal choroidal vasculopathy (PCV) in individualized treatment regimens based on the outcomes during 2 years
Eight patients were excluded from the current study, because even though the patients met the criteria of the monthly treatment schedule, they could not return for monthly visits during the third year because of proximity to the clinic, absence of available ophthalmic clinicians, or the treatment schedule for as-needed injections based on quarterly examinations was selected for the third-year treatment
28 eyes received as-needed injections based on quarterly examinations, 61 eyes received asneeded injections based on monthly examinations, 18 eyes received monthly ranibizumab injections, and 21 eyes had a During the third year Age During the first During During year including the the three monthly second third injections year year
Summary
To investigate the third-year results of ranibizumab monotherapy for polypoidal choroidal vasculopathy (PCV) in individualized treatment regimens based on the outcomes during 2 years. At a mean 7.3 years after initiation of intensive ranibizumab treatment, about one third of patients had a VA of 20/70 or better Snellen equivalent, and almost one quarter had good vision (20/40 or better). The fellow non-study eyes had wet AMD, and 6% of patients were legally blind, with 20/200 vision or worse bilaterally. The results suggested that to maintain the VA gain in patients with neovascular AMD treated with ranibizumab, patients may have to be followed more frequently than quarterly or treated more frequently. Recent trials [3,4,5,6,7] have reported that as-needed ranibizumab injections based on monthly examinations could be effective if patients strictly adhered
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