Measuring the benefit of 4 years of intravitreal ranibizumab treatment for neovascular age-related macular degeneration

• Published in: British journal of ophthalmology Vol. 96; no. 12; pp. 1469 - 1473
• Main Authors: Pushpoth, Sreekumari, Sykakis, Evripidis, Merchant, Kinnar, Browning, Andrew C, Gupta, Rajen, Talks, S James
• Format: Journal Article
• Language: English
• Published: BMA House, Tavistock Square, London, WC1H 9JR BMJ Publishing Group Ltd 01.12.2012; BMJ Publishing Group; BMJ Publishing Group LTD
• Subjects: Aged; Aged, 80 and over; Antibodies, Monoclonal, Humanized - administration & dosage; Biological and medical sciences; Choroid; Degeneration; Female; Fluorescein Angiography; Follow-Up Studies; Fundus Oculi; Humans; Intravitreal Injections; Macula; Macular Degeneration - drug therapy; Macular Degeneration - etiology; Macular Degeneration - physiopathology; Male; Medical sciences; Middle Aged; Miscellaneous; Neovascularisation; Ophthalmology; Ranibizumab; Retina - pathology; Retinal Neovascularization - complications; Retinal Neovascularization - drug therapy; Retinal Neovascularization - physiopathology; Retinopathies; Retrospective Studies; Time Factors; Treatment other; Treatment Outcome; Visual Acuity - drug effects; Immunomodulator; Eye disease; Retinopathy; Vascular endothelium growth factor; Treatment; Ranibizumab; Vitreous body; Age related macular degeneration; Monoclonal antibody; Neovascularization; Ophthalmology; Antiangiogenic agent
• ISSN: 0007-1161; 1468-2079
• DOI: 10.1136/bjophthalmol-2012-302167

Aim To analyse the benefit of intravitreal ranibizumab over 4 years for patients with neovascular age-related macular degeneration (AMD). Methods A retrospective case note review of all patients who started treatment between August 2007 and September 2009 in our unit, minimum follow-up 2 years, maximum 4 years. The main outcome measures were: numbers of patients with different levels of vision, changes in visual acuity, number of treatments and numbers remaining under follow-up. Results 1086 eyes of 1017 patients received treatment. Numbers of patients remaining under follow-up were 892/1017 (87.71%) at 12 months, 730/1017 (71.78%) at 24 months, 468/730 (64.11%) at 36 months and 110/217 (50.69%) at48 months. The main reasons for patients no longer being under follow-up were the consequences of old age or transfer of care. 50% of patients had 6/18 or better over 4 years. Patients received on average 5.79±2.53, 9.15±3.79, 11.22±4.92 and 13.7±7.84 injections by 12, 24, 36 and 48 months, respectively. Conclusions We suggest that the numbers of patients with a particular level of vision may best reflect the actual benefit of AMD treatment provided by a service. Long-term follow-up is required as only 72/730 (10%) had been discharged at 36 months, half of whom had good vision of greater than 60 letters. 83% and 65% of patients needed treatment in the third and fourth year. Follow-up may be for the rest of the patients’ life or at some point they may no longer be well enough to attend.