Predictive factors for non-response to intravitreal ranibizumab treatment in age-related macular degeneration

Abstract

Background/aims: To study the initial characteristics and response to intravitreal ranibizumab (IVR) treatment of age-related macular degeneration (AMD).

Methods: We reviewed the clinical records of 141 eyes in 141 AMD patients who received monthly IVR for 3 months and thereafter pro re nata (PRN) injections for 9 months as the first treatment for AMD. Patients whose best corrected visual acuity (BCVA) worsened at month 12, and those with increased exudative fundus findings after IVR or an increased central retinal thickness of more than 100 μm at month 12, were considered to be non-responders as judged by BCVA and fundus findings, respectively. Non-responders' initial characteristics were analysed using logistic regression models.

Results: 14.9% of eyes were non-responders as judged by BCVA, and 17.0% were non-responders as judged by fundus findings. Initial fibrovascular pigment epithelial detachment (PED) (OR 22.9, 95% CI 2.61 to 201) and serous PED (OR 4.12, 95% CI 1.08 to 15.8) were associated with non-response as judged by BCVA. Initial fibrovascular PED (OR 33.5, 95% CI 2.95 to 381) and type 1 choroidal neovascularization (OR 6.46, 95% CI 1.39 to 30.0) were associated with non-response, as judged by fundus findings.

Conclusions: Although most AMD responded to IVR, non-responders had initial clinical characteristics that might be informative for managing their treatment.

Keywords: Degeneration; Macula; Neovascularisation; Retina; Treatment Medical.

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Figures

Figure 1

A non-responder as judged by fundus findings with fibrovascular pigment epithelial detachment (PED). This was a 71-year-old man with typical age-related macular degeneration and best corrected visual acuity (BCVA) of 0.3 (logMAR 0.52) at the time of initial intravitreal ranibizumab (IVR). Fluorescein (top row, left two panels, early phase and late phase) and indocyanine green (bottom row, left two panels, early phase and late phase) angiograms were consistent with the findings of the fundus colour photograph and an optical coherence tomography image showing fibrovascular PED before initial IVR (top row, right two panels). After seven IVR injections, the BCVA worsened to 0.15 (logMAR 0.82) at month 12. Although the fibrovascular PED did not change markedly, there was an increase in the subretinal and intraretinal fluid at month 12 (bottom row, right two panels).

Figure 2

Distribution of non-responders according to AMD type, as judged by fundus findings. Non-responders are shown in black in each bar. The numbers of non-responders and responders are included in the graph. AMD, age-related macular degeneration; CNV, choroidal neovascularisation; PCV, polypoidal choroidal vasculopathy; RAP, retinal angiomatous proliferation.

Figure 3

A responder as judged by fundus findings with retinal angiomatous proliferation (RAP). This was an 85-year-old man with an initial best corrected visual acuity (BCVA) of 0.1 (logMAR 1.0). Initial fluorescein (top row, left two panels, early phase and late phase) and indocyanine green (bottom row, left two panels, early phase and late phase) angiograms and colour fundus photograph (top row, centre panel) showed a typical RAP lesion. Initial central retinal thickness (CRT) measured in the optical coherence tomography image was 708 μm (top row, right panel). At month 12, the BCVA was improved to 0.4 (logMAR 0.4), all the exudative fundus findings had improved or disappeared, and the CRT was reduced to 194 μm (bottom row, right two panels).