Wiener klinische Wochenschrift

, Volume 124, Issue 21–22, pp 750–755 | Cite as

The significance of early treatment of exudative age-related macular degeneration: 12 months’ results

  • Birgit Weingessel
  • Gregor Hintermayer
  • Saskia M. Maca
  • Renate Rauch
  • Pia Veronika Vecsei-Marlovits
original article

Summary

Background

To assess whether the period between initial symptoms and therapy with ranibizumab in patients with choroidal neovascularization (CNV) influences visual outcome after a follow-up of 12 months.

Methods

Fifty patients with CNV were retrospectively split into three groups depending on the duration of visual symptoms: group I: < 1 month, group II: 1–6 months, and group III: > 6 months. Best-corrected visual acuity (BCVA) and central retinal thickness (CRT) were recorded at baseline, 2, 6, and 12 months. Patients received two initial intravitreal injections of 0.5 mg ranibizumab at baseline and reinjections as needed.

Results

The mean time span between initial symptoms and treatment was 66 ± 63 days. A longer duration of visual symptoms was significantly correlated with a lower BCVA at baseline, but also after 6 and 12 months.

Conclusions

Shorter duration of visual symptoms prior to treatment is associated with a better visual outcome.

Keywords

choroidal neovascularization age-related macular degeneration as-needed duration of symptoms ranibizumab time to first treatment 

Die Wichtigkeit einer frühen Behandlung bei exsudativer altersabhängiger Makuladegeneration – 12 Monats-Ergebnisse

Zusammenfassung

Hintergrund

Ziel dieser Studie war es, einen möglichen zeitlichen Einfluss zwischen Auftreten von Symptomen und Beginn einer Therapie bei choroidaler Neovaskularisation (CNV) auf das Sehvermögen nach einem Beobbachtungszeitraum von 12 Monaten herauszufinden.

Methodik

Fünfzig PatientInnen mit CNV wurden retrospektiv in drei Gruppen abhängig von der Symptomdauer geteilt: Gruppe I: < 1 Monat, Gruppe II: 1–6- Monate, Gruppe III: > 6 Monate. Der bestkorrigierte Visus und die zentrale Netzhautdicke wurden zu Beginn, nach 2, 6 und 12 Monaten erhoben. Die PatientInnen erhielten zwei initiale Injektionen mit 0,5 mg Ranibizumab in den Glaskörper. Weitere Injektionen wurden bei Bedarf verabreicht.

Ergebnisse

Die durchschnittliche Dauer zwischen Erstauftreten der Symptome und Beginn der Behandlung betrug 66 ± 63 Tage. Eine längere Symptomdauer korrelierte signifikant mit einem schlechteren Ausgangsvisus, aber auch mit einem schlechteren Sehvermögen nach 6 und 12 Monaten.

Schlussfolgerungen

Je kürzer die Symptomdauer vor Beginn der Behandlung ist, desto besser ist das Visusergebnis nach 12 Monaten.

Schlüsselwörter

choroidale Neovaskularisation altersabhängige Makuladegeneration Symptomdauer Ranibizumab Behandlungsbeginn 

Notes

Conflict of interest

The authors have no proprietary interest in any material presented in the study. Pia Veronika Vecsei-Marlovits and Birgit Weingessel received support by the Novartis Company for presentations and consultancy not associated with this study.

References

  1. 1.
    Kahn HA, Leibowitz HM, Ganley JP, et al. The Framingham Eye Study. I. Outline and major prevalence findings. Am J Epidemiol. 1977;106:17–32.PubMedGoogle Scholar
  2. 2.
    Klaver CC, Wolfs RC, Vingerling JR, Hofman A, de Jong PT. Age-specific prevalence and causes of blindness and visual impairment in an older population: the Rotterdam Study. Arch Ophthalmol. 1998;116:653–8.PubMedGoogle Scholar
  3. 3.
    Spitzer MS, Ziemssen F, Bartz-Schmidt KU, Gelisken F, Szurman P. Treatment of age-related macular degeneration: focus on ranibizumab. Clin Ophthalmol. 2008;2:1–14.PubMedCrossRefGoogle Scholar
  4. 4.
    Macular Photocoagulation Study Group. Five-year follow-up of fellow eyes of patients with age-related macular degeneration and unilateral extrafoveal choroidal neovascularization. Arch Ophthalmol. 1993;111:1189–99.CrossRefGoogle Scholar
  5. 5.
    Barouch FC, Miller JW. Anti-vascular endothelial growth factor strategies for the treatment of choroidal neovascularization from age-related macular degeneration. Int Ophthalmol Clin. 2004;44:23–32.PubMedCrossRefGoogle Scholar
  6. 6.
    Rosenfeld PJ, Brown DM, Heier JS, et al. MARINA Study Group. Ranibizumab for neovascular age-related macular degeneration. N Engl J Med. 2006;355:1419–31.PubMedCrossRefGoogle Scholar
  7. 7.
    Furino C, Boscia F, Recchimurzo N, et al. Intravitreal bevacizumab for treatment-naive subfoveal occult choroidal neovascularization in age-related macular degeneration. Acta Ophthalmol. 2009;87:404–7.PubMedCrossRefGoogle Scholar
  8. 8.
    Kaiser PK. Antivascular endothelial growth factor agents and their development: therapeutic implications in ocular diseases. Am J Ophthalmol. 2006;42:660–8.CrossRefGoogle Scholar
  9. 9.
    Ladewig MS, Karl SE, Hamelmann V, et al. Combined intravitreal bevacizumab and photodynamic therapy for neovascular age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol. 2008;246:17–25.PubMedCrossRefGoogle Scholar
  10. 10.
    Ng EW, Adamis AP. Targeting angiogenesis, the underlying disorder in neovascular age-related macular degeneration. Can J Ophthalmol. 2005;40:352–68.PubMedGoogle Scholar
  11. 11.
    Singer MA, Awh CC, Sadda S, et al. HORIZON: An open-label extension trial of ranibizumab for choroidal neovascularization secondary to age-related macular degeneration. Ophthalmology. 2012;119(6):1175–83.PubMedCrossRefGoogle Scholar
  12. 12.
    Brown DM, Kaiser PK, Michels M, et al. ANCHOR Study Group. Ranibizumab versus verteporfin for neovascular age-related macular degeneration. N Engl J Med. 2006;355:1432–44.PubMedCrossRefGoogle Scholar
  13. 13.
    Boyer DS, Antoszyk AN, Awh CC, Bhisitkul RB, Shapiro H, Acharya NR. MARINA Study Group. Subgroup analysis of the MARINA study of ranibizumab in neovascular age-related macular degeneration. Ophthalmology. 2007;114:246–52.PubMedCrossRefGoogle Scholar
  14. 14.
    Rosenfeld PJ, Rich RM, Lalwani GA. Ranibizumab: Phase III clinical trial results. Ophthalmol Clin North Am. 2006;19:361–72.PubMedGoogle Scholar
  15. 15.
    Lalwani GA, Rosenfeld PJ, Fung AE, et al. A variable-dosing regimen with intravitreal ranibizumab for neovascular age-related macular degeneration: year 2 of the PrONTO Study. Am J Ophthalmol. 2009;148(1):43–58.PubMedCrossRefGoogle Scholar
  16. 16.
    Klein ML, Jorizzo PA, Watzke RC. Growth features of choroidal neovascular membranes in age-related macular degeneration. Ophthalmology. 1989;96:1416–9.PubMedGoogle Scholar
  17. 17.
    Vander JF, Morgan CM, Schatz H. Growth rate of subretinal neovascularization in age-related macular degeneration. Ophthalmology. 1989;96:1422–6.PubMedGoogle Scholar
  18. 18.
    Muether PS, Hermann MM, Koch K, Fauser S. Delay between medical indication to anti-VEGF treatment in age-related macular degeneration can result in a loss of visual acuity. Graefes Arch Clin Exp Ophthalmol. 2011;249:633–7.PubMedCrossRefGoogle Scholar
  19. 19.
    Schalnus R, Meyer CH, Kuhli-Hattenbach C, Luchtenberg M. Time between symptom onset and assessment in age-related macular degeneration with subfoveal choroidal neovascularization. Ophthalmologica. 2010;224:176–82.PubMedCrossRefGoogle Scholar
  20. 20.
    Oliver-Fernandez A, Bakal J, Segal S, Shah GK, Dugar A, Sharma S. Progression of visual loss and time between initial assessment and treatment of wet age-related macular degeneration. Can J Ophthalmol. 2005;40:313–9.PubMedGoogle Scholar
  21. 21.
    Algvere PV, Steén B, Seregard S, Kvanta A. A prospective study on intravitreal bevacizumab (Avastin) for neovascular age-related macular degeneration of different durations. Acta Ophthalmol. 2008;86:482–9.PubMedCrossRefGoogle Scholar
  22. 22.
    Rauch R, Weingessel B, Maca SM, Vécsei-Marlovits PV. Time to first treatment—the significance of early treatment of exudative age related macular degeneration. Retina. 2011;32(7):1260–4.Google Scholar
  23. 23.
    Heimes B, Lommatzsch A, Zeimer M, et al. Long-term visual course after anti-VEGF therapy for exudative AMD in clinical practice evaluation of the German reinjection scheme. Graefes Arch Clin Exp Ophthalmol. 2011;249:639–44.PubMedCrossRefGoogle Scholar
  24. 24.
    Dadgostar H, Ventura AA, Chung JY, Sharma S, Kaiser PK. Evaluation of injection frequency and visual acuity outcomes for ranibizumab monotherapy in exudative age-related macular degeneration. Ophthalmology. 2009;116:1740–7.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Wien 2012

Authors and Affiliations

  • Birgit Weingessel
    • 1
    • 2
  • Gregor Hintermayer
    • 3
  • Saskia M. Maca
    • 1
  • Renate Rauch
    • 1
    • 2
  • Pia Veronika Vecsei-Marlovits
    • 1
    • 2
  1. 1.Department of OphthalmologyHietzing HospitalViennaAustria
  2. 2.Karl Landsteiner Institute for Process Optimization and Quality Management in Cataract SurgeryViennaAustria
  3. 3.Department of OphthalmologySt. Poelten HospitalSt. PoeltenAustria

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