Five-year treatment outcomes following intravitreal ranibizumab injections for neovascular age-related macular degeneration in Japanese patients

• Published in: Graefe's archive for clinical and experimental ophthalmology Vol. 257; no. 7; pp. 1411 - 1418
• Main Authors: Wada, Iori, Oshima, Yuji, Shiose, Satomi, Kano, Kumiko, Nakao, Shintaro, Kaizu, Yoshihiro, Yoshida, Shigeo, Ishibashi, Tatsuro, Sonoda, Koh-hei
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.07.2019; Springer Nature B.V
• Subjects: Acuity; Age; Atrophy; Clinical outcomes; Immunotherapy; Injection; Macular degeneration; Medicine; Medicine & Public Health; Monoclonal antibodies; Ophthalmology; Retinal Disorders; Vascularization; Macular atrophy; Pro re nata treatment; Long-term treatment; Age-related macular degeneration; Ranibizumab
• ISSN: 0721-832X; 1435-702X
• DOI: 10.1007/s00417-019-04361-8

Purpose To assess the real-world 5-year treatment outcomes of ranibizumab therapy in Japanese patients with neovascular age-related macular degeneration (AMD). Methods This was a retrospective, observational, and open-label effectiveness study that included 295 eyes. The participants were patients with treatment-naïve neovascular AMD who received intravitreal ranibizumab (IVR) monthly injection at least three times as the loading phase, followed by further injections as needed (pro re nata (PRN)) and follow-up assessments for 5 years. Outcomes were determined at least 5 years after the first ranibizumab injection. Results Mean logMAR best-corrected visual acuity (BCVA) at baseline was 0.52. The mean BCVA significantly improved after three loading injections; however, it declined gradually. The BCVA at 1 year was significantly better than the baseline BCVA, whereas the 3-year, 4-year, and 5-year BCVA values were significantly lower than the baseline values. The average central foveal thickness improved significantly from 366 ± 125 μm to 268 ± 134 μm ( p  < 0.0001). Macular atrophy was significantly more likely to occur in cases with classic choroidal neovascularization (CNV) than in cases with other AMD ( p  = 0.01). Conclusions IVR is well tolerated in eyes with AMD. However, a PRN regimen for AMD may have limited real-world effectiveness for long-term maintenance of improved visual acuity. Macular atrophy may occur more frequently in classic CNV. To maintain good vision, IVR treatment should be started earlier and performed continuously.