PURPOSE: To report the efficacy and safety of intravitreal ranibizumab for neovascular age-related macular degeneration (nAMD) in real-world practice.
METHODS: Metaanalysis of ∼26,360 patients from 42 real-world observational studies reporting outcomes of intravitreal ranibizumab for nAMD published between 2007 and 2015. Baseline demographics, lesion type, and visual acuity (VA) were recorded. The weighted mean was calculated for change in VA and frequency of injections and visits during year 1, year 2, and ≥3 years. Local and systemic adverse events were recorded.
RESULTS: The mean change in VA for patients receiving a treat-and-extend regimen was +8.8 (95% confidence interval [CI]: 5.8 to 11.8), +6.7 (95% CI: 3.2 to 10.1), and +5.4 (95% CI: -4.1 to 14.9) Early Treatment Diabetic Retinopathy Study (ETDRS) letters at 1 year (n = 1,539), 2 years (n = 2,521), and ≥3 years (n = 1,298), in comparison with +3.5 (95% CI: 2.0 to 5.0), +1.3 (95% CI: -1.6 to 4.2), and -1.9 (95% CI: -9.8 to 6.0) ETDRS letters for pro re nata at 1 year (n = 20,247), 2 years (n = 14,408), and ≥3 years (n = 11,714). Treat-and-extend patients received on average more injections (6.9 vs. 4.7) but had fewer visits (7.6 vs. 9.2) in the first year. Baseline characteristics were similar between the regimens. The reported rate of endophthalmitis was 17 of 66,176 intravitreal injections (0.026%).
CONCLUSION: Intravitreal ranibizumab for nAMD prevents severe visual loss in real-world practice. Patients can achieve visual gain from baseline, but the extent to which these are maintained in the long term may depend on the frequency of injections.

/pdf/metaanalysis-of-real-world-outcomes-of-intravitreal-3dcrec1dg0.pdf

Metaanalysis of real-world outcomes of intravitreal ranibizumab for the treatment of neovascular age-related macular degeneration

Four-year treatment results of neovascular age-related macular degeneration with ranibizumab and causes for discontinuation of treatment.

Purpose:To evaluate the occurrence of retinal pigment epithelial atrophy in patients with age-related macular degeneration undergoing anti–vascular endothelial growth factor therapy.Methods:The study is a retrospective review. Eligible were patients with age-related macular degeneration and choroida

Retinal pigment epithelial atrophy in patients with exudative age-related macular degeneration undergoing anti-vascular endothelial growth factor therapy.

The Impact of Anti–Vascular Endothelial Growth Factor Treatment on Quality of Life in Neovascular Age-Related Macular Degeneration

The Swedish Lucentis Quality Registry is a 12-month, open-label, observational, prospective, and retrospective study of ranibizumab administration for wet AMD. Visual acuity (VA) was measured with Snellen or ETDRS chart in 370 patients (66.8% women; age range 46–93 years). In total, a mean of 4.7 ± 1.6 injections per patient (range 1–10) was given to month 12. Mean VA score was 58.3 ± 12.2 letters before treatment, 63.3 ± 12.5 after 3 injections (Δ4.9 ± 10.1 letters from baseline), and 59.3 ± 16.2 at 12 months (Δ1.0 ± 13.6). VA score from baseline to month 12 was stable in 74.4% of patients, improved by 15 letters/3 lines or more in 14.7%, and decreased by ≥15 letters/3 lines in 10.9% of patients. With a mean of 4.7 ranibizumab injections per patient per year, mean VA was stabilised but not increased. To maintain the initial gain seen after the first three injections, an average of 1.8 ± 1.5 additional injections does not appear to be adequate.

/pdf/one-year-outcomes-using-ranibizumab-for-neovascular-age-1mn1z7eyix.pdf

One-year outcomes using ranibizumab for neovascular age-related macular degeneration: results of a prospective and retrospective observational multicentre study.

Introduction: The aim of this study was to evaluate the effect of initial treatment regimen individualization (pro re nata or treat-and-extend [TAE]), according to macular neovascularization (MNV) subtype, on the functional and anatomical response in neovascular age-related macular degeneration (nAMD). The secondary objective was to compare the treatment burden between each MNV subtype. Methods: Consecutive treatment-naïve nAMD patients were retrospectively included. MNV subtype was graded by 2 independent blinded investigators on multimodal imaging. Functional and anatomical outcomes were analysed according to treatment regimen and MNV subtypes. Results: A total of 281 eyes from 243 patients were included in the study. According to the treatment regimen, there was no significant difference in best-corrected visual acuity gain within the first 2 years of treatment for type 1 (p = 0.106) and type 3 MNV (p = 0.704). Conversely, there was a significant difference in favour of TAE regimen for type 2 (p = 0.017) and type 4 MNV (p = 0.047). Type 1 MNV had a higher proportion of visits with subretinal fluid (p = 0.0007) but not with intraretinal fluid (p = 0.22). The mean interval between the last 2 injections was significantly shorter for type 1 MNV (p = 0.0045). Conclusion: The individualization of the initial treatment protocol according to MNV subtype can improve the functional outcome and may decrease the treatment burden.

The Effects of Treatment Regimen on the Initial Management of Macular Neovascularization Subtypes in Age-Related Macular Degeneration

Background To analyse the 24-month outcomes of intravitreal ranibizumab injections for choroidal neovascularisation (CNV) secondary to age-related macular degeneration (AMD). Methods The authors reviewed the charts of all consecutive eyes with CNV secondary to AMD, who underwent one intravitreal ranibizumab injection (followed by a pro re nata (1+PRN) decision to retreat or to not retreat) at least 24 months before. Best-corrected visual acuity (BCVA) changes and central macular thickness (CMT) were retrospectively assessed, from baseline (m0) to month 12 (m12), and 24 (m24). Results Ninety-six eyes of 79 patients (23 male, 56 female, aged 63–90 years) were included for analysis. The number of intravitreal injections administered ranged from 1 to 16. The mean BCVA significantly improved from m0 (0.78±0.33) to m12 (0.61±0.39, p Conclusion In this study, similarly to other studies of variable dosing regimen over 24 months, intravitreal ranibizumab was effective in significantly increasing BCVA and reducing CMT.

https://bjo.bmj.com/content/bjophthalmol/94/3/292.full.pdf

Ranibizumab for exudative age-related macular degeneration: 24-month outcomes from a single-centre institutional setting.

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The Effects of Treatment Regimen on the Initial Management of Macular Neovascularization Subtypes in Age-Related Macular Degeneration

Ranibizumab for exudative age-related macular degeneration: 24-month outcomes from a single-centre institutional setting.