Clinical Risk Factors for Poor Anatomic Response to Ranibizumab in Neovascular Age-Related Macular Degeneration§

Josef Guber*, 1, Tatjana Josifova 2, Paul Bernhard Henrich 2, Ivo Guber 3
1 Sutton Eye Hospital, Epsom and St Helier University Hospitals, London, UK
2 Department of Ophthalmology, University of Basel, Basel, Switzerland
3 Eye Clinic, Cantonal Hospital of Winterthur, Winterthur, Switzerland

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© Guber et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Sutton Eye Hospital, Epsom and St Helier University Hospitals, NHS Trust, Cotswold Road, London, SM2 5NF, UK; Tel: +44 20 8296 2000; Fax: +44 20 8770 7051; E-mail:
§ Presented at the Annual Congress of the Royal College of Ophthalmologists, Liverpool, UK, May 2013.



To identify OCT-based anatomical features and clinical characteristics for poor central retinal thickness (CRT) response to ranibizumab in neovascular age-related macular degeneration (AMD).

Patients and Methods:

Investigating our electronic patient records (Eyeswide), patients with neovascular AMD treated with intravitreal injections of 0.5mg/0.05ml ranibizumab were identified and their notes reviewed. Data collected included gender, age, initial best-corrected visual acuity (BCVA), prior photodynamic therapy, lesion type (classic versus occult), type of macular edema (intraretinal fluid, subretinal fluid, pigment epithelium detachment) and the total number of previous ranibizumab injections.


A total of 210 eyes of 182 patients with neovascular AMD were identified. Mean follow-up time was 1.34 years (SD ± 0.77). Central retinal thickness reduction in women was significantly inferior to that in men (p=0.05). Patients with cystoid type macular edema had significantly greater reduction in CRT compared to patients with subretinal fluid (p<0.001) or pigment epithelium detachment (p<0.001). The percentage drop of CRT was no longer statistically significant after the sixth injection. Age, initial BCVA, prior photodynamic therapy and lesion type had no statistically effect on CRT response.


Risk factors for poor central retinal thickness response to ranibizumab include female gender and patients with predominant subretinal fluid or pigment epithelium detachment. Furthermore, the anatomical response decreased after the sixth injection of ranibizumab.

Keywords: Age-related macular degeneration, Lucentis, poor-responder, ranibizumab, risk factors.