Effects of Ranibizumab in Patients with Subfoveal Choroidal Neovascularization Attributable to Age-related Macular Degeneration

PURPOSE: To demonstrate not only prevention of vision loss but also improvement in best-corrected visual acuity (BCVA) after treatment with ranibizumab on a variable-dosing regimen over 24 months in patients with age-related macular degeneration (AMD). DESIGN: Interventional case series. METHODS: SETTING: Institutional. STUDY POPULATION: One hundred and thirty-eight eyes of 138 patients treated intravitreally with 0.5 mg ranibizumab (Lucentis; Novartis, Basel, Switzerland). Age above 50 years, BCVA 0.2 to 1.2 logarithm of the minimal angle of resolution (logMAR), primary or recurrent subfoveal choroidal neovascularization (CNV) secondary to AMD. OBSERVATION PROCEDURES: After single initial treatment, Monthly follow-up examination. Retreatment in case of one of the following: sign of subretinal fluid or intraretinal edema, increase in central retinal thickness (CRT) on optical coherence tomography (OCT), active CNV on fluorescein angiography, increase of metamorphopsia, and loss of BCVA >5 letters on Early Treatment Diabetic Retinopathy Study (ETDRS) chart. MAIN OUT-COME MEASURES: Compared with baseline: proportion of eyes gaining 15 letters, proportion of eyes losing or gaining < 15 letters, change in CRT. RESULTS. After 24 months, 30% of eyes gained >= 15 letters. After 24 months, 55% of eyes lost or gained < 15 letters. Mean CRT of 386 +/- 145 mu m at baseline was significantly reduced to 211 +/- 39 mu m after 24 months (P = .036). Mean injection number per patient was 5.6 +/- 2.9 and 4.3 +/- 3.8 from baseline to month 12 and month 12 to 24, respectively. CONCLUSION: Intravitreal ranibizumab on a variable-dosing regimen was effective in significantly increasing mean BVCA and reducing CRT. This beneficial outcome was achieved with a low-rate of mild ocular adverse effects among our patients. (Am J Ophthalmol 2009;147: 831-837. (c) 2009 by Elsevier Inc. All rights reserved.)