Influence of the Vitreomacular Interface on Outcomes of Ranibizumab Therapy in Neovascular Age-related Macular Degeneration
| Autor: | Ulrike Mayr-Sponer, Christian Simader, Ursula Schmidt-Erfurth, Andrea Papp, Markus Ritter, I. Golbaz, Michael Kundi, Sebastian M. Waldstein, Ursula Heiling |
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| Rok vydání: | 2013 |
| Předmět: |
Male
medicine.medical_specialty Visual acuity genetic structures Visual Acuity Angiogenesis Inhibitors Tissue Adhesions Antibodies Monoclonal Humanized Posterior vitreous detachment law.invention Double-Blind Method Retinal Diseases Randomized controlled trial law Ranibizumab medicine Humans Prospective Studies Aged business.industry Macular degeneration medicine.disease Vitreomacular adhesion eye diseases Surgery Vitreous Body Ophthalmology Regimen Treatment Outcome Choroidal neovascularization Intravitreal Injections Retreatment Wet Macular Degeneration Female sense organs medicine.symptom business Tomography Optical Coherence medicine.drug |
| Zdroj: | Ophthalmology. 120:2620-2629 |
| ISSN: | 0161-6420 |
| DOI: | 10.1016/j.ophtha.2013.05.032 |
| Popis: | 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-naive 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. Financial Disclosure(s) Proprietary or commercial disclosure may be found after the references. |
| Databáze: | OpenAIRE |
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