gms | German Medical Science

25th Annual Meeting of the German Retina Society

German Retina Society

01.06. - 02.06.2012, Münster

Long-term effects of ranibizumab treatment delay in neovascular age-related macular degeneration

Meeting Abstract

  • Philipp S. Müther - Universitäts-Augenklinik Köln
  • R. Hörster - Universitäts-Augenklinik Köln
  • M.M. Hermann - Universitäts-Augenklinik Köln
  • B. Kirchhof - Universitäts-Augenklinik Köln
  • S. Fauser - Universitäts-Augenklinik Köln

German Retina Society. 25th Annual Conference of the German Retina Society. Münster, 01.-02.06.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. Doc12rg25

doi: 10.3205/12rg25, urn:nbn:de:0183-12rg252

This is the translated version of the article.
The original version can be found at:

Published: May 30, 2012

© 2012 Müther et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Background: Intravitreal injections of ranibizumab are the standard of care for neovascular age-related macular degeneration (AMD). In clinical trials comparable efficacy has been shown for either monthly injections or as needed injections upon monthly controls. Unlike in trial settings treatment in clinical routine is often delayed by complex approval procedures of health insurances and limited short-term surgical capacities.

Methods: Eighty-nine patients with neovascular AMD were followed for 12 months. Early treatment diabetic retinopathy study (ETDRS) visual acuity (VA), Radner reading VA and spectral domain optical coherence tomography were performed monthly. After an initial loading phase of three consecutive monthly intravitreal injections with ranibizumab, re-injections were performed after approval whenever recurrent or persistent activity of choroidal neovascularization (CNV) was detected.

Results: After an initial increase to a value of +5.0±11.87 ETDRS letters from baseline, VA constantly decreased over 12 months to a value of –0.66±16.82 ETDRS letters below baseline. Central retinal thickness (CRT) decreased from a value of 438.1±191.4 µm at baseline to a value of 289.9±138.6 µm after initial therapy and stabilized at a value of 322.4±199.5 µm. Loss of VA during latency between indication to treat and treatment was significantly greater than re-gain of VA after re-initiation of therapy (–2.2±5.0 versus 0.4±7.4 letters; p=0.046).

Conclusion: Latency between indication to treat and treatment is responsible for irreversible VA deterioration. A successful PRN treatment regimen for neovascular AMD requires immediate access to therapy after indication.