The Effect of Required Injection Numbers during the First Year on the Clinical Course of Neovascular Age-related Macular Degeneration

Aims: To evaluate the effect of injection number of ranibizumab on an as-needed treatment regimen during the first year of treatment on the clinical course of neovascular age-related macular degeneration (nAMD).

Study Design: Retrospective study.

Place and Duration of Study: Beyoglu Eye Training and Research Hospital. Department of Retina, between December 2009 and December 2011.

Methodology: The newly diagnosed nAMD patients who were treated with intravitreal ranibizumab on an as-needed treatment regimen with a follow-up period of at least 24 months were included in the study. The patients were divided into three groups according to the required injection numbers during the first year; group 1, 3 injections; group 2, 4-5 injections; group 3≥5 injections. Main outcome measures were the change in best corrected visual acuity (BCVA), and central retinal thickness (CRT). Secondary outcome measure was the number of injections during the second year.

Results: The study included 92 eyes of 87 patients. Group 1 consisted of 14 eyes (15.2%), group 2 consisted of 30 eyes (32.6%), and group 3 consisted of 48 eyes (52.2%). The visual outcomes seemed better in group 1; however, there was not a statistically significant difference among the three groups in regards of change in BCVA at all of the time points (p=0.4 for month 6, p=0.5 for month 12, p=0.6 for month 18, p=0.6 for month 24). There was not a statistically significant difference among the three groups in regards of change in CRT at all of the time points (p=0.2 for month 6, p=0.2 for month 12, p=0.1 for month 18, p=0.6 for month 24). The mean number of injections at month 12 and 24 was statistically different among the three groups (p<0.0001 for both).

Conclusion: This study did not show a relationship between injection numbers and treatment outcomes in patients with nAMD on an as-needed treatment regimen. However there was a difference among the three groups in regard of visual acuity which was not statistically significant.