Intravitreal Ranibizumab Treatment Research Articles

One-year results of intravitreal ranibizumab for neovascular age-related macular degeneration and clinical responses of various subgroups

To report 1-year clinical outcomes of intravitreal ranibizumab treatment for choroidal neovascularization (CNV) due to age-related macular degeneration (AMD) and to identify predictive factors that may influence visual acuity (VA) outcomes in Korean patients. Sixty patients (64 eyes) with subfoveal CNV were followed up over 12 months after intravitreal injection (0.5 mg) of ranibizumab at baseline and subsequent injections on an as-needed basis. The VA outcomes over 12 months were compared with baseline VA and evaluated across subgroups based on sex, age, baseline VA, CNV size, CNV type, and presence or absence of systemic disease and prior photodynamic therapy. VA improved or remained stable in 46 of 64 eyes (71.9%) at 12 months. Subgroup analysis showed that both baseline VA and CNV size influenced VA outcomes after ranibizumab treatment (P = 0.039, P = 0.042, respectively). However, the patients' sex (P = 0.643), baseline age (P = 0.361), CNV type (P = 0.940), and the presence or absence of systemic disease (P = 0.775) and prior photodynamic therapy (P = 0.890) did not affect VA outcomes. Intravitreal injections of ranibizumab improve mean VA in patients with subfoveal CNV secondary to AMD, and baseline VA and CNV lesion size were predictive factors of VA outcomes after ranibizumab treatment in Korean patients.

Intravitreal ranibizumab (Lucentis®) in the treatment of retinal angiomatous proliferation (RAP)

Retinal angiomatous proliferation (RAP) is a distinct variant of neovascular age-related macular degeneration (AMD). The aim of this study is to evaluate the functional and anatomic outcome after intravitreal ranibizumab (Lucentis) treatment in patients with RAP. Prospective study of consecutive patients with newly diagnosed or recurrent RAP treated with intravitreal ranibizumab at the Jules Gonin Eye Hospital between March 2006 and December 2007. Baseline and monthly follow-up visits included best-corrected visual acuity (BCVA), fundus exam and optical coherence tomography. Fluorescein and indocyanine green angiography were performed at baseline and repeated at least every 3 months. Thirty-one eyes of 31 patients were treated with 0.5 mg of intravitreal ranibizumab for RAP between March 2006 and December 2007. The mean age of the patients was 82.6 years (SD:4.9). The mean number of intravitreal injections administered for each patient was 5 (SD: 2.4, range 3 to 12). The mean follow up was 13.4 months (SD: 3, range 10 to 22). The baseline mean logMAR BCVA was 0.72 (SD: 0.45) (decimal equivalent of 0.2). The mean logMAR BCVA was improved significantly (P < 0.0001) at the last follow-up to 0.45, SD: 0.3 (decimal equivalent 0.35). The visual acuity (VA) improved by a mean of 2.7 lines (SD 2.5). Mean baseline central macular thickness (CMT) was 376 microm, and decreased significantly to a mean of 224 microm (P < 0.001) at the last follow-up. Mean reduction of CMT was 152 microm (SD: 58). An average of 81.5% of the total visual improvement and 85% of the total CMT reduction occurred during the first post-operative month after one intravitreal injection of ranibizumab. During follow-up, an RPE tear occurred in one eye (3.2%) of the study group. No injection complications or systemic drug-related side-effects were noted during the follow-up period. Intravitreal ranibizumab injections appeared to be an effective and safe treatment for RAP, resulting in visual gain and reduction in macular thickness. Further long-term studies to evaluate the efficacy of intravitreal ranibizumab in RAP are warranted.

COMBINATION PHOTODYNAMIC THERAPY AND INTRAVITREAL RANIBIZUMAB IN NEOVASCULAR AGE-RELATED MACULAR DEGENERATION IN A NORTH INDIAN POPULATION

To evaluate photodynamic therapy (PDT) with verteporfin along with intravitreal ranibizumab in treatment of neovascular age-related macular degeneration. This prospective interventional care series included 16 patients (17 eyes) of choroidal neovascularization secondary to neovascular age-related macular degeneration who were treated with PDT with verteporfin followed by an injection of 0.5 mg ranibizumab on the same day. The main outcome measures were best corrected visual acuity as recorded by both Snellen and Early Treatment Diabetic Retinopathy Study (ETDRS) charts (logMAR), contrast sensitivity (Pelli-Robson Chart), retreatment frequency, and frequency of side effects. Seventeen eyes underwent PDT with verteporfin and intravitreal 0.5 mg ranibizumab, following PDT. Patients were followed up every month for a total period of 6 months. Initial visual acuity ranged from CF to 20/32 and final acuity ranged from CF to 20/20. Visual acuity stabilized (gain/loss <2 lines) in 14 out of 17 eyes (82.35%) and improved in 3 out of 17(17.65%). Contrast sensitivity improved in 15 out of17 eyes (82.24%) There were no cases of ocular/systemic adverse events. Retreatment was required in only 2 out of 17 cases (11.76%) with a single injection of intravitreal ranibizumab. The combination of PDT with intravitreal ranibizumab improves contrast sensitivity and stabilizes vision and reduces the number of retreatments, without significant ocular/systemic risks.

COMBINATION PHOTODYNAMIC THERAPY AND INTRAVITREAL RANIBIZUMAB IN NEOVASCULAR AMD IN A NORTH INDIAN POPULATION

To evaluate photodynamic therapy (PDT) with verteporfin along with intravitreal Ranibizumab in treatment of neovascular age related macular degeneration. This prospective interventional care series included 16 patients (17 eyes) of choroidal neovascularization secondary to neovascular AMD, who were treated with PDT with verteporfin followed by an injection of 0.5mg Ranibuzimab on the same day. The main outcome measures were best corrected visual acuity (VA) as recorded by both Snellen's and ETDRS charts (logMAR), contrast sensitivity (Pelli-Robson Chart), retreatment frequency and frequency of side effects. Seventeen eyes underwent PDT with verteporfin and intravitreal 0.5mg Ranibizumab, following PDT. Patients were followed up every month for a total period of 6 months. Initial VA ranged from CF to 20/32 and final acuity ranged from CF to 20/20. VA stabilizes (gain/loss <2 lines) in 14 out of 17 eyes (82.24%) and improved in 3 out of 17 (17.65%). Contrast sensitivity improved in 15 out of 17 eyes (82.24%) Lesion type, patient age had no influence on the outcome. There were no cases of ocular/systematic adverse events. Retreatment was required in only 2 out of 17 cases (11.76%) with only a single injection of ranibizumab. The combination of PDT with intravitreal Ranibizumab improves contrast sensitivity and stabilizes vision and reduces the number of retreatments, without significant ocular and/or systematic risks.

Ranibizumab Combined With Verteporfin Photodynamic Therapy in Neovascular Age-Related Macular Degeneration

To investigate the safety and efficacy of intravitreal ranibizumab treatment combined with verteporfin photodynamic therapy (PDT) in patients with predominantly classic choroidal neovascularization secondary to age-related macular degeneration. In this 2-year, phase I/II, multicenter, randomized, single-masked, controlled study, patients received monthly ranibizumab (0.5 mg) (n = 106) or sham (n = 56) injections. The PDT was performed 7 days before initial ranibizumab or sham treatment and then quarterly as needed. Proportion of patients losing fewer than 15 letters from baseline visual acuity at 12 months (primary efficacy outcome) and the incidence and severity of adverse events. At 12 months, 90.5% of the ranibizumab-treated patients and 67.9% of the control patients had lost fewer than 15 letters (P<.001). The most frequent ranibizumab-associated serious ocular adverse events were intraocular inflammation (11.4%) and endophthalmitis (1.9%; 4.8% if including presumed cases). On average, patients with serious inflammation had better visual acuity outcomes at 12 months than did controls. Key serious nonocular adverse events included myocardial infarctions in the PDT-alone group (3.6%) and cerebrovascular accidents in the ranibizumab-treated group (3.8%). CONCLUSION/APPLICATION TO CLINICAL PRACTICE: Ranibizumab + PDT was more efficacious than PDT alone for treating neovascular age-related macular degeneration. Although ranibizumab treatment increased the risk of serious intraocular inflammation, affected patients, on average, still experienced visual acuity benefit.