gms | German Medical Science

24rd Annual Meeting of the German Retina Society

German Retina Society

17.06. - 18.06.2011, Aachen

Subjective treatment success and subjective recurrence detection after ranibizumab treatment in exsudative AMD

Meeting Abstract

  • Philipp S. Muether - Universitäts-Augenklinik Köln
  • R. Hörster - Universitäts-Augenklinik Köln
  • K. Koch - Universitäts-Augenklinik Köln
  • M.M. Hermann - Universitäts-Augenklinik Köln
  • B. Kirchhof - Universitäts-Augenklinik Köln
  • S. Fauser - Universitäts-Augenklinik Köln

German Retina Society. 24th Annual Conference of the German Retina Society. Aachen, 17.-18.06.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. Doc11rg07

DOI: 10.3205/11rg07, URN: urn:nbn:de:0183-11rg075

This is the translated version of the article.
The original version can be found at: http://www.egms.de/de/meetings/rg2011/11rg07.shtml

Published: June 15, 2011

© 2011 Muether et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

Text

Background: Ranibizumab therapy of exsudative AMD is cost intensive and invasive. European drug approval requires time intense follow-ups for justification of retreatment upon recurrence of choroidal neovascularization (CNV). We have studied whether 1.) ranibizumab therapy resulted in clinically relevant improvement for the patient, and 2.) have tested the sensitivity of patient self control, Amsler grid, visual acuity assessment, fundus examination and SD-OCT in detecting CNV recurrence.

Methods: ETDRS visual acuity (VA), Radner reading VA, reading speed (words per minute, wpm), Amsler, subjective impression, funduscopy and SD-OCT were performed in 74 patients before and after initial ranibizumab treatment series. Objective and subjective functional changes were correlated. After CNV involution, monthly controls were conducted in 40 patients. Upon appearance of SD-OCT-confirmed novel fluid, classified as morphologic recurrence, sensitivity of objective and subjective functional deterioration were compared to OCT.

Results: ETDRS VA improved from 55+13.6, gaining 3.2+12.0 (p=0.026), reading speed of 54+26 wpm gained 20.7+44 wpm (p<0.001). 68% (n=50) of patients perceived improvement, 21% (n=16) no change and 11% (n=8) deterioration. Subjective impression and objective functions correlated for each group (p=0.002, p<0.001, p=0.043). Regression analysis confirmed correlation between objective VA change and subjective perception (p=0.001). Subjective perception was independent of better or worse eye treated (p=0.826). Proportion of recurrence detection compared to 40 OCT-morphologic recurrences (100%): subjective deterioration 6 (15%); increase of metamorphopsia 12 (30%); ETDRS- and/or Radner VA loss of > one line 11 (28%); funduscopic 10 (25%); cumulative sensitivity 27 (67.5%).

Conclusion: Ranibizumab treatment success in AMD is not only statistically significant, but despite intensity and invasiveness clinically relevant for the patient. Regarding recurrence detection, SD-OCT outclasses all other psycho/physic examination methods. Morphologic recurrences can be detected prior to functional deterioration.