Ranibizumab's Impact on Pigment Epithelial Detachment With or Without RPE Tears

Age-related macular degeneration (AMD) is one of the driving conditions behind pigment epithelial detachment (PED). One of the treatment options for PEDs is ranibizumab injection (marketed under the name Lucentis). But just how effective is this treatment?

David Eichenbaum, MD, an ophthalmologist from Florida, presented data from the HARBOR study at the 34^th Annual Scientific Meeting of the American Society of Retina Specialists (ASRS 2016) in San Francisco, California. The study aimed to identify the effects of ranibizumab on eyes with PED, including those that developed retinal pigment epithelial (RPE) tears.

Detachments were categorized by small (35 to 164 µm), medium (164.5 to 233 µm), large (233.25 to 351 µm) or extra-large (352 to 1395.5 µm). Each of these categories were represented by 25% of the study population.

“Vision improvement was similar regardless of PED resolution at month 24,” Eichenbaum said at ASRS 2016. “Each group gained about eight letters.” Therefore, regardless of PED size at baseline, there were similar outcomes across the spectrum.

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PED completely resolved in about 50% of the cohort and there were some additional benefits with ranibizumab 2.0 mg monthly, however — “Vision improved rapidly with ranibizumab 0.5 mg treatment, yet on average, vision gains were lower with 2.0 mg,” Eichenbaum explained.

The next part of this analysis looked at the incidence of RPE tears during the study and how that impacted visual outcomes. Twenty-eight of the 598 (5%) patients with PED at baseline suffered from RPE tears. Out of the 28 eyes, 21 of them occurred in patients with extra-large PEDs at baseline. Most of the new tears happened within the first three months.

The researchers did not observe an association between PED presence and macular atrophy at month 24. No matter what, there was about a 30% incidence of macular atrophy. However, the rate of detection of macular atrophy was significantly higher in eyes with complete flattening of PED at month 24 — 17% vs. 44%.

As Eichenbaum pointed out, two takeaways to remember were (1) only 5% of patients with PED developed RPE tears during the study period and (2) complete PED resolution was associated with a higher rate of macular atrophy by 24 months.

Eichenbaum said that this begs the question of if ophthalmologists should go for the PED or look at the fluid beneath the RPE.

“In conclusion, quadrupling the dose of anti-VEGF to 2.0 mg was associated with some additional atomic improvement, but on average vision gains were lower,” he said.

Also on MD Magazine >>> More News from ASRS 2016 in San Francisco