Predictors of 1-year visual outcome in neovascular age-related macular degeneration following intravitreal ranibizumab treatment

Abstract

Purpose: To describe predictors of visual outcome in patients treated with intravitreal ranibizumab for choroidal neovascularisation (CNV) in age-related macular degeneration (AMD).

Methods: Retrospective review of 279 patients with CNV in AMD who fulfilled MARINA/ANCHOR study eligibility criteria and were treated with repeated intravitreal injections of ranibizumab 0.5 mg in routine clinical practice, beginning with three initial injections at 4-week intervals followed by individualized retreatment for the subsequent 9 months. Study parameters included best-corrected visual acuity (BCVA) and morphological characteristics.

Results: Mean BCVA relative to baseline was +4.7 (p < 0.0001), +4.2 (p < 0.0001)and -0.4 (p > 0.667) Early Treatment Diabetic Retinopathy Study letters after 3, 6 and 12 months, respectively, after a mean of 5.1 injections when the proportion of patients with BCVA ≥ 70 letters had doubled compared with baseline. Predictive factors for BCVA ≤ 35 letters after 12 months were BCVA ≤ 35 letters at baseline and month 3 (p < 0.0001) while BCVA ≥ 70 letters at month 12 was associated with BCVA ≥ 70 letters at baseline and month 3 (p < 0.001) and with total lesion size <4 DA (p = 0.0147).

Conclusion: Under a ranibizumab regimen with substantially fewer injections than with fixed four-weekly injection regimens, BCVA was improved compared with the natural history of neovascular AMD, but did not achieve the visual gain observed in randomized clinical trials using fixed 4-week retreatment. Visual acuity at month 3, after the initial fixed-interval injections, was the strongest predictor of BCVA at month 12.