Efficacy of ranibizumab in eyes with

significant hemorrhage from

neovascular AMD
Tara Golisch, BS
Josh Robinson, MD
Jonathan L. Prenner, MD
Financial Disclosures
•Consultant
•Opko
•Ophthotech
•Neovista
•Alcon
•J&J
•Genentech
Background:
•Most AMD trials exclude eyes with >50% blood

•No prospective evidence to guide management in these eyes

Background:
•Some eyes likely require surgical intervention
•Massive hemorrhage
•Significant breakthrough bleeding

•What should the approach be in eyes with less severe hemorrhages?

Is anti-VEGF therapy
effective in eyes like these?
Hypothesis:
•Eyes with >50% hemorrhage may do well with anti-VEGF therapy

•Examine the efficacy of ranibizumab in these less well studied eyes

Methods:
•Retrospective review
•29 eyes of 29 patients
•Presented with CNV complexes that had >50% blood
•Treatment naive
•Monotherapy with ranibizumab
Methods:
•Fifty five percent were taking anticoagulation
Methods:
•All patients had
•Three injections of ranibizumab
•Fifteen weeks of follow up
•Baseline and 15 week FA
•Allowed for measurement of lesions and subsequent analysis
Methods:
•Endpoints
•Anatomic: amount of blood resolution
•Functional: change in snellen visual acuity
Baseline:
Week 15:
Baseline:
Week 15:
Results:
Results:
blood composition
•Baseline
•77.6% blood
•Range 51-100% 

•Week 15
•9.5% blood
•Range 0-50%
Results:
visual acuity
•Baseline
•20/200 -1
•Range (CF to 20/30) 

•Week 15
•20/200 +2
•Range (CF to 20/25)
Results: No Change
Lost > 3 lines
Lost <3 lines
Gaines >3 lines

visual acuity
Gained <3 lines

•Three line gainers: 34%

•Non responders: 7%
Conclusions:
•This cohort of eyes typically excluded in clinical trials responded well
•Anatomically: most eyes had significant blood resolution
•Functionally: visual data mirrored large prospective trials
Conclusions:
•Anti-VEGF monotherapy seems reasonable in this cohort of patients

•Prognosis seems better than might be expected in these less well

studied eyes
Mahalo