Four-year treatment results of neovascular age-related macular degeneration with ranibizumab and causes for discontinuation of treatment

Am J Ophthalmol. 2013 Jan;155(1):89-95.e3. doi: 10.1016/j.ajo.2012.06.031. Epub 2012 Sep 27.


Purpose: To evaluate 4-year treatment results of neovascular age-related macular degeneration with ranibizumab using a variable dosing regimen.

Design: Retrospective, single-center chart review.

Methods: This was a retrospective single-center study that included 855 patients with neovascular age-related macular degeneration receiving treatment with ranibizumab during a 4-year period. Included in the study were patients with a minimum follow-up of 15 months and all patients who terminated treatment regardless of follow-up.

Results: A total of 1321 patients were treated over the 4-year period, and 855 patients were eligible for inclusion. Of those, 456 patients were still receiving active treatment, whereas 399 patients had discontinued treatment. Overall treatment results showed a significant decrease in vision from 53.2 Early Treatment Diabetic Retinopathy Study letters (range, 1 to 85 letters) to 50.5 letters (range, 1 to 87 letters; P < .001). Mean follow-up was 23.3 months (range, 4 to 48 months). The reason for discontinuing treatment in 181 patients was no signs of activity, whereas 113 patients were judged to be nontreatable. Thirty-six patients declined further treatment for various reasons.

Conclusions: This report shows that when follow-up extends beyond 2 to 3 years, visual acuity does seem to decrease. Our data show that different responder groups can be identified: bad or nonresponders (approximately 15% of all patients) and good responders (approximately 21% of all patients). These 2 groups in general can be identified within the first 2 years of treatment, whereas the third group of regular responders (approximately 64% of all patients) require continuous monitoring and treatment for years.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Angiogenesis Inhibitors / administration & dosage
  • Angiogenesis Inhibitors / therapeutic use*
  • Antibodies, Monoclonal, Humanized / administration & dosage
  • Antibodies, Monoclonal, Humanized / therapeutic use*
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Ranibizumab
  • Retreatment
  • Retrospective Studies
  • Time Factors
  • Tomography, Optical Coherence
  • Treatment Outcome
  • Visual Acuity / physiology
  • Wet Macular Degeneration / diagnosis
  • Wet Macular Degeneration / drug therapy*
  • Wet Macular Degeneration / physiopathology
  • Withholding Treatment / statistics & numerical data*


  • Angiogenesis Inhibitors
  • Antibodies, Monoclonal, Humanized
  • Ranibizumab