Influence of the vitreomacular interface on outcomes of ranibizumab therapy in neovascular age-related macular degeneration.

Abstract

PURPOSE:

To investigate the influence of the vitreomacular interface (VMI) on the functional and anatomic efficacy of ranibizumab therapy in patients with neovascular age-related macular degeneration (AMD).

DESIGN:

Subanalysis of a prospective, 12-month, multicenter, phase IIIb trial.

PARTICIPANTS:

A total of 353 treatment-naïve patients with subfoveal choroidal neovascularization (CNV) receiving quarterly or monthly ranibizumab therapy.

METHODS:

On monthly optical coherence tomography (OCT) scan sets, the VMI configuration was graded by a certified reading center into one of the following conditions: continuous posterior vitreoretinal attachment (PVA), vitreomacular adhesion (VMA), partial vitreous detachment without vitreomacular contact, or complete posterior vitreous detachment (PVD). Best-corrected visual acuity (BCVA) and central retinal thickness (CRT) measurements were performed at monthly intervals. Analysis included patients with a minimum of 10 OCT examinations, including baseline and month 12 (n = 251). After integration of the VMI configuration over 12 months, patients were divided into one of the following categories: PVD (n = 162), release of vitreomacular contact (RELEASE; n = 48), VMA (n = 37), or PVA (n = 4). General estimation equation analyses were applied to test for noninferiority of quarterly versus monthly treatment.

MAIN OUTCOME MEASURES:

The BCVA and CRT changes at month 12.

RESULTS:

Mean BCVA changes in letters were +4.7 (PVD), +3.2 (RELEASE), and -0.2 (VMA) in the quarterly regimen and +4.9 (PVD), +12.7 (RELEASE), and +7.5 (VMA) in the monthly regimen. No difference in therapeutic efficiency between monthly and quarterly intervention was found in eyes with PVD, and quarterly treatment was noninferior to monthly treatment (P = 0.001). However, monthly treatment was superior to quarterly treatment in the RELEASE (P = 0.008) and VMA (P = 0.043) groups. Mean CRT changes were -98 and -96 μm (PVD), -117 and -136 μm (RELEASE), and -93 and -87 μm (VMA) in the monthly and quarterly regimens, respectively, without statistically significant differences.

CONCLUSIONS:

The configuration of the VMI seems to have an important effect on visual outcomes and need for retreatment. In patients with PVD, a lower treatment frequency may be feasible, whereas patients with RELEASE or VMA may benefit from intensive retreatment. These findings may serve as a basis for individualized treatment decisions in anti-angiogenic therapy of neovascular AMD and perhaps other indications.

• Authors: Ulrike Mayr-Sponer, Sebastian M Waldstein, Michael Kundi, Markus Ritter, Isabelle Golbaz, Ursula Heiling, Andrea Papp, Christian Simader, Ursula Schmidt-Erfurth
• Journal: Ophthalmology (Ophthalmology) Vol. 120 Issue 12 Pg. 2620-2629 (Dec 2013) ISSN: 1549-4713 [Electronic] United States
• PMID: 23870300 (Publication Type: Clinical Trial, Phase III, Journal Article, Multicenter Study, Randomized Controlled Trial)
• Copyright: Copyright © 2013 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

Chemical References

• Angiogenesis Inhibitors
• Antibodies, Monoclonal, Humanized
• Ranibizumab

Topics

• Aged
• Angiogenesis Inhibitors (therapeutic use)
• Antibodies, Monoclonal, Humanized (therapeutic use)
• Double-Blind Method
• Female
• Humans
• Intravitreal Injections
• Male
• Prospective Studies
• Ranibizumab
• Retinal Diseases (pathology)
• Retreatment
• Tissue Adhesions
• Tomography, Optical Coherence
• Treatment Outcome
• Visual Acuity (physiology)
• Vitreous Body (pathology)
• Wet Macular Degeneration (drug therapy)