Ranibizumab for treatment of exudative age-related macular degeneration – own experience

Summary
It is commonly agreed nowadays that one of the key elements of neovascular age-related macular degeneration (AMD) pathogenesis is deregulation of the angiogenesis factors. Treatment of subfoveal choroidal neovascularizations (CNV) in course of AMD was limited to photodynamic therapy with verteporfin (PDT). The new approach to CNV treatment is to discover and eliminate factors, which directly induce CNV development. Extended studies have allowed to employ inhibitors of vascular endothelial growth factor (VEGF) for a treatment of neovascular AMD. Numerous of anti-VEGF compounds are still under developing in pre-clinical or phase-1/2 clinical studies whereas 2 of them have completed phase 3 of clinical trials. The newest compound that was launched on drug market is ranibizumab (Lucentis®). Ranibizumab is a recombinant humanized IgG1 isotype, monoclonal antibody fragment designed for intravitreal use. Ranibizumab binds to and inhibits the biologic activity of human vascular endothelial growth factor A (VEGF-A). It has been proved on the base of MARINA and ANCHOR clinical trials that treatment ranibizumab is effective and save for patients treated for CNV secondary to AMD.

Purpose
Interventional case series.

Material and methods
67 eyes of 67 patients with all angiographic subtypes of wet AMD were treated with 0.5 mg of intravitreal ranibizumab, injected monthly for first 3 doses. Next doses were injected according to specified re-treatment criteria as assessed in monthly follow-up.

Results
Mean change in visual acuity (VA) was +12.4 ETDRS letters. Percent of patient losing less than 15 ETDRS letters was 93.2%. Percent of patient gaining VA more than 3 ETDRS letters was 43.4%.

Conclusions
Intravitreal ranibizumab is effective in treatment of CNV due to AMD. A significant number of patients have improved theirs VA. Implementation of anti-VEGF therapy for treatment of ocular diseases gave a new hope for patient that previously couldn’t be treated with any of method.