Abstract
Purpose: To evaluate the effect of ranibizumab monotherapy in patients with neovascular age related macular degeneration (AMD) associated with a pigment epithelial detachment (PED). Methods: A retrospective chart review of neovascular AMD with associated PED treated using initial three monthly doses of ranibizumab followed by as needed dosing. The response to treatment was assessed by evaluating changes in visual acuity and central macular thickness (CMT) by ocular coherence tomography. The total ranibizumab injections needed was also assessed. Results: A total of 14 eyes from 12 patients were included in this study. The average follow up period was 35 months (range 17 - 62 months). The mean logMAR visual acuity decreased from 0.596 (snellen ~ 20/80) to 1.018 (snellen ~20/200), however this was not statistically significant (p=0.05). The mean central macular thickness (CMT) also decreased from initial CMT 258 to final CMT 277.08. There was no statistically significant difference between the initial and final CMT (p=0.60). An average of 10 ranibizumab injections per eye (range 3-23 injections) was administered over the duration of the study. Conclusions: Our pilot study suggests that ranibizumab monotherapy administered on an as needed basis, in cases of patients with neovascular AMD with PED may be of questionable benefit. The treatment modality appeared to be ineffective in improving visual acuity as well as CMT. Combined treatment approaches may be necessary at an early stage to prevent visual loss in these cases.
Highlights
Age-related macular degeneration (AMD) is the leading cause of severe and irreversible vision loss among patients over 50 years of age [1,2]
These studies have shown that about one third of patients with ARMD improve in visual acuity by at least 15 letters [6,8], anecdotally we noted that a subset of these patients with pigment epithelial detachment (PED) more often than not, respond poorly to ranibizumab monotherapy
The goal of this study is to report our findings of ranibizumab monotherapy using variable dosing in these patients
Summary
Age-related macular degeneration (AMD) is the leading cause of severe and irreversible vision loss among patients over 50 years of age [1,2]. Bevacizumab and ranibizumab (antiVEGF antibody) are the mainstay of treatment for neovascular AMD Pivotal clinical trials such as MARINA [6] and ANCHOR [8], as well as PrONTO [9] have all demonstrated the efficacy of ranibizumab in terms of preservation and improvement of visual acuity in patients with neovascular ARMD over photodynamic therapy (PDT). These studies have shown that about one third of patients with ARMD improve in visual acuity by at least 15 letters [6,8], anecdotally we noted that a subset of these patients with pigment epithelial detachment (PED) more often than not, respond poorly to ranibizumab monotherapy. The goal of this study is to report our findings of ranibizumab monotherapy using variable dosing in these patients
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