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Monthly intravitreal injections needed to maintain VEGF suppression
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Intravitreal injections of 0.5 mg ranibizumab should be scheduled within 29-day intervals to allow for continuous suppression of VEGF in patients with exudative age-related macular degeneration, a study found.
“An injection scheme every 4 weeks should provide adequate VEGF inhibition in all patients,” the study authors said.
The nonrandomized, prospective clinical study included 47 eyes of 47 patients with exudative AMD who were administered intravitreal ranibizumab injections. Before each injection, spectral-domain optical coherence tomography, funduscopy and visual acuity testing were performed. Aqueous humor specimens were taken before and after each injection to measure VEGF factor A levels.
The main outcome measures were vision loss, recurrence of choroidal neovascularization and intraocular VEGF concentration.
Complete VEGF suppression was demonstrated for a mean period of 37.8 days after intravitreal injection.
Mean recurrence of CNV activity was observed at 93.7 days after the last ranibizumab treatment. Mean visual acuity loss occurred at 114.3 days. VEGF levels were never suppressed when a recurrence was observed.
“When continuous suppression of VEGF is intended in 90% of the patients, intravitreal ranibizumab applications have to be scheduled within 29 days or less,” the authors said. “The recurrences of CNV are preceded by loss of VEGF suppression and followed by loss of visual acuity.”
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