1. Fibrovascular pigment epithelial detachment (PED) and serous PED were associated with non-response to intravitreal ranibizumab treatment as determined by visual acuity testing.
2. Fibrovascular PED and type 1 choroidal neovascularization were associated with non-response as determined by fundus findings.
Evidence Rating Level: 2 (Good)
Study Rundown: For age-related macular degeneration (AMD), intravitreous ranibizumab is an effective treatment option for many patients. A small subset of patients however, do not respond to this treatment. In this study, patients with AMD were reviewed to identify and characterize non-responders to intravitreal ranibizumab treatment. The authors found that several factors were associated with non-response to the anti-VEGF treatment as determined by best-corrected visual acuity (BCVA) and fundus findings. These factors include initial fibrovascular pigment epithelial detachment (PED), serous PED, and type 1 choroidal neovascularization. An important strength of this study is a large patient sample size. Limitations in this study include the retrospective study design, which makes it difficult to establish a causal relationship, as well as the large 95% confidence intervals. Nonetheless, this study suggests that ophthalmologists should be aware of these potential predictive factors when treating AMD patients with intravitreal ranibizumab.
In-Depth [retrospective cohort]: This study retrospectively reviewed the clinical records of 141 eyes in 141 AMD patients. All patients received a monthly intravitreal injection of ranibizumab for 3 months followed by PRN intravitreal injections for 9 months. Non-responders to the anti-VEGF treatment were defined as patients with worsened BCVA, increased exudative fundus findings and/or an increased central retinal thickness at 12 months. Logistic regression models were created to analyze non-responders’ initial characteristics. Initial fibrovascular PED (OR=22.9, 95%CI=2.61-201) and serous PED (OR=4.12, 95%CI=1.08-15.8) were associated with non-response to ranibizumab treatment as determined by BCVA. Initial fibrovascular PED (OR=33.5, 95%CI=2.95-381) and type 1 choroidal neovascularization (OR=6.46, 95%CI=1.39-30.0) were associated with non-response as determined by fundus findings.
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