Long-term outcomes of intravitreal ranibizumab for neovascular AMD
Reviewed by Jonathan Chan

This is a single centre prospective study for the long-term, whole population ‘real-world’ clinical outcomes of ranibizumab therapy in treatment-naïve patients for neovascular age-related macular degeneration (AMD). This study recorded: demographics, Early Treatment Diabetic Retinopathy Study visual acuity (ETDRS VA) at all visits, injection dates, central 1mm retinal thickness, and operative and postoperative complications. In total, 1483 eyes from 1278 patients were included in this study. The median age at the time of the patient’s first injection was 82.5 years. Comorbidity was present in 7.3% eyes. The baseline VA was 23-39, 40-54, 55-70 and >70 ETDRS letters for 17.3%, 23.1%, 42.7% and 16.9% of eyes, respectively. The median VA in all baseline VA groups improved after the loading phase but declined back to the baseline level by two to five years. The rate of endophthalmitis following intravitreal injection was one in 2124 injections. Other complications noted were raised intraocular pressure in 2.7%, subconjuctival haemorrhage in 2.1%, corneal epithelial abrasion in 1.8%, pain in 1.3%, floaters after operation in 0.8% and other complications in 0.8%. The authors conclude that the VA increases during the loading phase, but returns to near baseline levels after two to five years of treatment for each baseline VA category. Patients should be identified and treated as early as possible, since presenting VA predicts the VA maintained after five years of treatment. National Institute for Health & Care Excellence (NICE) guidance advising treatment only for eyes with vision below 70 letters does not promote best long-term VA outcomes for patients. In addition, the authors commented that the strength of this paper includes a large number of patients and eyes representing almost a total population treated for neovascular AMD in a geographical area. Vision data was extracted from electronic medical records for a defined data set at the point of care and contrasts with voluntary registry approaches to data collation by clinicians. A limitation of this study is that the sample sizes decrease with each year leading to a higher standard of errors for the estimates in the latter years of the study period. 

Long-term outcomes of intravitreal ranibizumab for neovascular age-related macular degeneration in a well defined region of the UK.
Buckle M, Donachie PHJ, Johnston RL.
BRITISH JOURNAL OF OPTHALMOLOGY
2016;100:240-5.