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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.

journal_name

Ophthalmology

journal_title

Ophthalmology

authors

Mayr-Sponer U,Waldstein SM,Kundi M,Ritter M,Golbaz I,Heiling U,Papp A,Simader C,Schmidt-Erfurth U

doi

10.1016/j.ophtha.2013.05.032

subject

Has Abstract

pub_date

2013-12-01 00:00:00

pages

2620-2629

issue

eissn

0161-6420

issn

1549-4713

pii

S0161-6420(13)00489-2

journal_volume

120

pub_type

杂志文章,多中心研究,随机对照试验

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