Impact of vitreomacular adhesion on ranibizumab mono- and combination therapy for neovascular age-related macular degeneration
| Autor: | Ulrike Mayr-Sponer, Ursula Schmidt-Erfurth, Christian Simader, Sebastian M. Waldstein, Markus Ritter, Michael Kundi |
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| Rok vydání: | 2014 |
| Předmět: |
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medicine.medical_specialty Visual acuity Time Factors genetic structures Visual Acuity Tissue Adhesions Antibodies Monoclonal Humanized Posterior vitreous detachment Macular Degeneration Pro re nata Ranibizumab medicine Humans Macula Lutea Single-Blind Method Prospective Studies Aged Photosensitizing Agents business.industry Macular degeneration medicine.disease Verteporfin Vitreomacular adhesion eye diseases Choroidal Neovascularization Surgery Vitreous Body Ophthalmology Choroidal neovascularization Treatment Outcome Photochemotherapy Intravitreal Injections Drug Therapy Combination Female sense organs medicine.symptom business Tomography Optical Coherence medicine.drug Follow-Up Studies |
| Zdroj: | American journal of ophthalmology. 158(2) |
| ISSN: | 1879-1891 |
| Popis: | Purpose To investigate the influence of vitreomacular adhesion on the efficacy of pro re nata (PRN) ranibizumab monotherapy and verteporfin photodynamic therapy (PDT) combination therapy for neovascular age-related macular degeneration. Design Post hoc analysis of prospective randomized 12-month multicenter clinical trial data. Methods patient population: Total of 255 treatment-naive patients with subfoveal choroidal neovascularization. observation procedure: Assessment of the vitreomacular interface on monthly optical coherence tomography with division of patients into the following categories according to continuous 1-year grading: posterior vitreous detachment (n = 154), dynamic release of vitreomacular adhesion (n = 32), stable vitreomacular adhesion (n = 51). main outcome measures: Mean best-corrected visual acuity (BCVA) letter and central retinal thickness changes at month 12 in the vitreomacular interface groups. Results Mean BCVA changes at month 12 were +3.5 (posterior vitreous detachment), +4.3 (release of vitreomacular adhesion), and +6.3 (vitreomacular adhesion) in patients receiving monotherapy ( P = .767), and +0.1 (posterior vitreous detachment), +6.6 (release of vitreomacular adhesion), and +9.2 (vitreomacular adhesion) in patients receiving combination therapy ( P = .009). Mean central retinal thickness changes were −113 μm (posterior vitreous detachment), −89 μm (release of vitreomacular adhesion), and −122 μm (vitreomacular adhesion) in monotherapy ( P = .725) and −121 μm (posterior vitreous detachment), −113 μm (release of vitreomacular adhesion), and −113 μm (vitreomacular adhesion) in combination therapy ( P = .924). Mean ranibizumab retreatments during 12 months were 4.9 (posterior vitreous detachment), 6.6 (release of vitreomacular adhesion), and 5.3 (vitreomacular adhesion) in monotherapy ( P = .018) and 4.7 (posterior vitreous detachment), 5.2 (release of vitreomacular adhesion), and 5.8 (vitreomacular adhesion) in combination therapy ( P = .942). Conclusion This study adds evidence that the vitreomacular interface status impacts functional outcomes and retreatment requirements. Patients with posterior vitreous detachment achieve acceptable results with fewer injections in PRN monotherapy, but lose potential vision gain with PDT. Patients with other vitreomacular interface configurations may potentially achieve optimized vision outcomes by combination of antiangiogenic treatment and vaso-occlusive PDT. |
| Databáze: | OpenAIRE |
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