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Effect of posterior vitreous detachment on treat-and-extend versus monthly ranibizumab for neovascular age-related macular degeneration
  1. Sebastian M Waldstein,
  2. Leonard Coulibaly,
  3. Sophie Riedl,
  4. Amir Sadeghipour,
  5. Bianca S Gerendas,
  6. Ursula Margarethe Schmidt-Erfurth
  1. Christian Doppler Laboratory for Ophthalmic Image Analysis, Vienna Reading Center, Department of Ophthalmology, Medical University of Vienna, Vienna, Austria
  1. Correspondence to Professor Ursula Margarethe Schmidt-Erfurth, Department of Opththalmology, Medical University Vienna, 1090 Wien, Austria;{at}


Aims To investigate the impact of posterior vitreous detachment (PVD) on the efficacy of treat-and-extend (T&E) ranibizumab in neovascular age-related macular degeneration.

Methods In a post hoc analysis of a randomised controlled clinical trial, spectral-domain optical coherence tomography images of treatment-naïve patients randomised to receive T&E (n=265) or monthly (n=264) ranibizumab for 12 months were included. Certified, masked graders diagnosed the presence or the absence of complete PVD. The main outcome measures were the mean change in best-corrected visual acuity (BCVA) and central retinal thickness (CRT) at month 12, the number of administered ranibizumab injections and the proportion of patients extended to more than 8 weeks.

Results At baseline, complete PVD was present in 51% and 56% of patients in the monthly and T&E arms, respectively. Mean change in BCVA at month 12 was +9.0 (PVD) vs +9.5 letters (no PVD, p=0.78) in monthly treated eyes, and +6.0 (PVD) vs +7.5 letters (no PVD, p=0.42) in T&E treated eyes. Conversely, mean change in CRT at month 12 was −174 (PVD) vs −173 µm (no PVD, p=0.98) in the monthly arm, and −175 (PVD) vs −164 µm (no PVD, p=0.58) in the T&E arm. In T&E treated patients, the median number of injections was eight vs nine (p=0.035). 71% of PVD eyes were extended successfully, compared with 55% of eyes without PVD (p=0.005).

Conclusion PVD was not found to impact functional and anatomical outcomes of T&E ranibizumab therapy. However, patients without a complete PVD required more retreatments and were significantly less likely to be successfully extended.

Trial registration number NCT01948830

  • retina
  • imaging
  • macula
  • neovascularisation
  • vitreous

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  • Funding The financial support by the Austrian Federal Ministry for Digital and Economic Affairs and the National Foundation for Research, Technology and Development is gratefully acknowledged. The study was partially funded by Novartis Pharma AG, Basel, Switzerland. Novartis participated in the final review and approval of the manuscript.

  • Competing interests SMW served as consultant to Bayer and Novartis and received research funding from Bayer and Genentech. BSG served as a consultant to Roche, Novartis and Kinarus and received research funding from Novartis, Kinarus and IDx. UMS-E served as a consultant to Böhringer Ingelheim, Genentech, Novartis and Roche.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data may be obtained from a third party and are not publicly available.

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