Effect of posterior vitreous detachment on treat-and-extend versus monthly ranibizumab for neovascular age-related macular degeneration.

Abstract

AIMS:

To investigate the impact of posterior vitreous detachment (PVD) on the efficacy of treat-and-extend (T&E) ranibizumab in neovascular age-related macular degeneration.

METHODS:

In a post hoc analysis of a randomised controlled clinical trial, spectral-domain optical coherence tomography images of treatment-naïve patients randomised to receive T&E (n=265) or monthly (n=264) ranibizumab for 12 months were included. Certified, masked graders diagnosed the presence or the absence of complete PVD. The main outcome measures were the mean change in best-corrected visual acuity (BCVA) and central retinal thickness (CRT) at month 12, the number of administered ranibizumab injections and the proportion of patients extended to more than 8 weeks.

RESULTS:

At baseline, complete PVD was present in 51% and 56% of patients in the monthly and T&E arms, respectively. Mean change in BCVA at month 12 was +9.0 (PVD) vs +9.5 letters (no PVD, p=0.78) in monthly treated eyes, and +6.0 (PVD) vs +7.5 letters (no PVD, p=0.42) in T&E treated eyes. Conversely, mean change in CRT at month 12 was -174 (PVD) vs -173 µm (no PVD, p=0.98) in the monthly arm, and -175 (PVD) vs -164 µm (no PVD, p=0.58) in the T&E arm. In T&E treated patients, the median number of injections was eight vs nine (p=0.035). 71% of PVD eyes were extended successfully, compared with 55% of eyes without PVD (p=0.005).

CONCLUSION:

PVD was not found to impact functional and anatomical outcomes of T&E ranibizumab therapy. However, patients without a complete PVD required more retreatments and were significantly less likely to be successfully extended.

TRIAL REGISTRATION NUMBER:

NCT01948830.

• Authors: Sebastian M Waldstein, Leonard Coulibaly, Sophie Riedl, Amir Sadeghipour, Bianca S Gerendas, Ursula Margarethe Schmidt-Erfurth
• Journal: The British journal of ophthalmology (Br J Ophthalmol) Vol. 104 Issue 7 Pg. 899-903 (07 2020) ISSN: 1468-2079 [Electronic] England
• PMID: 31563866 (Publication Type: Clinical Trial, Phase III, Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: © Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.

Chemical References

• Angiogenesis Inhibitors
• VEGFA protein, human
• Vascular Endothelial Growth Factor A
• Ranibizumab

Topics

• Aged
• Aged, 80 and over
• Angiogenesis Inhibitors (administration & dosage, therapeutic use)
• Choroidal Neovascularization (diagnosis, drug therapy, physiopathology)
• Double-Blind Method
• Female
• Humans
• Intravitreal Injections
• Male
• Middle Aged
• Prospective Studies
• Ranibizumab (administration & dosage, therapeutic use)
• Retina (physiopathology)
• Tomography, Optical Coherence
• Treatment Outcome
• Vascular Endothelial Growth Factor A (antagonists & inhibitors)
• Visual Acuity (physiology)
• Vitreous Detachment (diagnostic imaging, physiopathology)
• Wet Macular Degeneration (diagnosis, drug therapy, physiopathology)