Intravitreal ranibizumab for neovascular age-related macular degeneration patients with good baseline visual acuity and the predictive factors for visual outcomes

Abstract

Purpose: To evaluate the efficacy of intravitreal ranibizumab for the treatment of neovascular age-related macular degeneration (nAMD) patients with a visual acuity (VA) of ≥ 20/40 and to investigate the predictive factors for visual outcomes.

Methods: The present study is a retrospective analysis of patients with VA ≥ 20/40. Injections were given monthly for the first 3 months and thereafter as needed. The patients were divided into two groups; group 1, patients not receiving further injections beyond the 3 loading doses, and group 2, those who received further injections. Next, group 2 was divided into two subgroups; group 2A, patients who did not experience VA loss, and group 2B, those who experienced VA loss. Data collected for each patient included VA and central retinal thickness (CRT) measured at baseline, months 3, 6, 9, and 12.

Results: The study included 96 eyes of 96 patients. Change in VA showed a significant inverse correlation with total number of injections at month 12 (r=-0.34, P=0.001), and the presence of pigment epithelial detachment (PED) at baseline (r=-0.35, P<0.01). VA outcomes were better in group 1 than group 2 at all time points (P<0.001 for all). Change in VA at month 3 was not significantly different between groups 2A and 2B (P=0.26); however, change in VA at month 6, 9, and 12 were statistically different between the two groups (P<0.001 for all).

Conclusion: Intravitreal ranibizumab is an effective treatment for nAMD patients with good VA. The presence of PED, need for reinjection, and VA loss were unfavorable prognostic factors.

Keywords: Acuité visuelle; Age-related macular degeneration; Décollement de l’épithélium pigmentaire; Dégénérescence maculaire liée à l’âge; Injection intravitréenne; Intravitreal injection; Ranibizumab; Retinal pigment epithelial detachment; Visual acuity.