DEC 19, 2013
This subanalysis of a phase 3, multicenter, prospective study found that the configuration of the vitreomacular interface seems to have an important effect on visual outcomes and need for retreatment in patients with wet AMD.
The authors analyzed results from the EXCITE study in which 353 treatment-naïve patients with wet AMD were randomized to monthly or quarterly ranibizumab injections, allowing for a distinct comparison between a continuous optimized regimen (monthly treatment) and a discontinuous treatment (quarterly treatment). Patients were monitored monthly using best corrected visual acuity (BCVA) and OCT. The vitreomacular interface was evaluated according to a standardized protocol by an independent central reading center.
For the quarterly regimen, mean BCVA change was +4.7 letters after 12 months in patients with posterior vitreous detachment (PVD), +3.2 in patients who showed release of vitreomacular contact and −0.2 in patients with vitreomacular adhesion. For the monthly regimen, the mean change was +4.9 for patients with PVD, +12.7 for patients with release of vitreomacular contact and +7.5 for patients with vitreomacular adhesion.
At 12 months there was no difference in therapeutic efficiency between monthly and quarterly intervention in eyes with PVD, and quarterly treatment was noninferior to monthly treatment (P = 0.001). However, monthly treatment was superior to quarterly treatment in eyes with release of vitreomacular contact (P = 0.008) and eyes with vitreomacular adhesion (P = 0.043).
The authors write that the findings of this article have potentially important implications for the design of future therapeutic trials of interventions for the treatment of wet AMD. While it is tempting to conclude that less intensive treatment regimens should be used in patients with PVD and more intensive treatment regimens in patients with release of vitreomacular contact or with vitreomacular adhesion, the practical implications of this for the treating physician may be limited. Novel imaging devices, such as higher-resolution fast-scanning OCT, will resolve this diagnostic issue.