gms | German Medical Science

Background: Intravitreal injections of ranibizumab are the most effective treatment of neovascular age-related macular-degeneration (AMD). Best results are obtained by monthly injections, or by pro-re-nata injections with monthly controls. It is desirable to find a dosing regimen that is effective at preserving vision, decreases the number of injections and avoids CNV recurrences. Aim of this study was to analyze the time intervals for recurrence of CNV activity.

Methods: Twenty-nine eyes of 28 patients with neovascular AMD and at least two recurrences of CNV activity after treatment with ranibizumab were included into the study. All patients received 3 monthly injections of ranibizumab whenever signs of active CNV were detected on optical coherence tomography (OCT) or fluorescein angiography. Recurrence intervals were calculated and periodical activity was considered if the difference between recurrence intervals was less than 50 days.

Results: Two to 6 recurrences were detected per case. Recurrence intervals ranged from 41 to 523 days (mean 5.5±3.5 months).Twenty-two eyes (76%) showed a periodical activity of at least 2 recurrence intervals. Twelve eyes (41%) showed periodical activity of all intervals. Seven eyes (24%) showed irregular recurrences. All 11 eyes with classic CNV lesion components showed at least 2 periodical recurrence intervals.

Conclusions: Preliminary data indicate that periodical recurrences of CNV activity may be seen in eyes with neovascular AMD undergoing anti-VEGF therapy. Knowledge of individual recurrence intervals may allow for an individualized treatment plan with prophylactic injections. Further studies need to show, if this regimen may improve the long term outcome.