Effectiveness of ranibizumab for neovascular age-related macular degeneration using clinician-determined retreatment strategy

Aims To report the effectiveness of intravitreal ranibizumab treatment for neovascular age-related macular degeneration in a tertiary centre. Methods 1 year prospective cohort study of patients with a diagnosis of neovascular age-related macular degeneration on fundus fluorescein angiography treated with ranibizumab. Patients received three consecutive monthly treatments, followed by a clinician-determined re-treatment strategy. Data collected included demographic details, baseline and subsequent follow-up visit measurements, refraction protocol best corrected visual acuity (BCVA), contrast sensitivity (CS) and central foveal thickness (CFT) on optical coherence tomography. Results 81 patients were included in the study. The mean age was 79.5 years with a male: female ratio 32:49. The mean number of treatments was 5.6 +/- 2.3. Visual outcomes at 12 months showed 17.1% gained >= 15 letters BCVA, 97.4% lost <15 letters and 2.5% lost >= 15 letters. Mean changes at 12 months were: BCVA +3.7 +/- 11.1 (p<0.01); CS + 2.3 +/- 5.1 letters (p<0.001); CFT -100.1 +/- 111.9 mu m (p<0.001). Conclusions Clinician-determined re-treatment after a three-dose initiation phase appears to be less effective in improving BCVA than in randomised controlled trials.