Bevacizumab versus ranibizumab in the treatment of exudative age-related macular degeneration

The purpose of this article is to describe functional and morphological short-term results in patients with exudative age-related macular degeneration (AMD) of all subtypes, treated with intravitreal bevacizumab versus intravitreal ranibizumab. This was a retrospective case-controlled series of 30 patients treated with intravitreal bevacizumab and 30 patients treated with intravitreal ranibizumab for exudative AMD. All patients received three initial injections every 4 weeks. Best corrected visual acuity (BCVA) as well as greatest linear dimension (GLD) of the CNV in fluorescein angiography and central retinal thickness (CRT) in optical coherence tomography (OCT) were monitored 2–4 months after last injection. BCVA stabilized and slightly increased from logMAR 0.74 to 0.62 in the bevacizumab group, and from logMAR 0.76 to 0.58 in the ranibizumab group (P < 0.05 for each group). No statistical difference was seen between both groups at any time-point. CRT was significantly reduced in both groups at last follow-up. In contrast, GLD did not change significantly. Patients with exudative AMD of all subtypes benefit from intravitreal anti-VEGF injections. No significant difference between bevacizumab and ranibizumab is seen in the short-term follow-up.     

Retinal pigment epithelium tears following ranibizumab for exudative age-related macular degeneration

PURPOSE: To report two cases of retinal pigment epithelium (RPE) tears following intravitreous ranibizumab injection for age-related macular degeneration (AMD)-associated serous pigment epithelium detachment (PED). DESIGN: Noncomparative case series. METHODS: The charts of two patients who received intravitreous ranibizumab for AMD-associated PED and developed RPE tears were reviewed. Fundus photography, fluorescein angiography and optical coherence tomography performed prior to injection and upon follow-up confirmed the diagnosis. RESULTS: Two patients with serous PED and occult choroidal neovascularization associated with AMD developed RPE tears within four weeks of injection with ranibizumab. CONCLUSIONS: RPE tears may complicate ranibizumab intravitreous injection for the treatment of AMD-associated PEDs. Further studies need be undertaken to determine whether this complication may also occur when treating choroidal neovascular membranes not associated with PED and whether certain angiographic subtypes are more susceptible to this complication.     

Intravitreal aflibercept treatment in eyes with exudative age-related macular degeneration following prior treatment with intravitreal ranibizumab

Background:

To investigate visual and anatomical outcomes in eyes with exudative age-related macular degeneration treated with intravitreal aflibercept following prior treatment with intravitreal ranibizumab.

Materials and Methods:

Retrospective, single-center study of 192 eyes treated with 0.5 mg intravitreal ranibizumab every 4 weeks for three consecutive doses followed by a variable dose schedule. After more than 12 months of ranibizumab treatment, eyes that required ranibizumab injections at 4-week or 6-week intervals were switched to aflibercept therapy.

Results:

After 12–69 months (42 months ± 18 months, mean ± standard deviation [SD]) of treatment with intravitreal ranibizumab, 80 eyes were changed to 2 mg intravitreal aflibercept treatment with follow-up after 12–18 months (16 months ± 1 month, mean ± SD). Thirty-nine eyes had persistent macular fluid after treatment with ranibizumab. Mean logMAR visual acuity (VA) in eyes treated with ranibizumab changed by − 0.089 ± 0.310 (mean ± SD; P = 0.0003), which correlates to an approximate gain of 4.5 letters. The number of eyes with macular fluid decreased from 39 to 23 after aflibercept treatment. Mean logMAR VA in eyes with intraretinal macular fluid treated with aflibercept changed by −0.079 ± 0.134 (mean ± SD; P = 0.006), which correlates to an approximate gain of 4 letters. Mean logMAR VA in eyes with submacular fluid was not significantly different after aflibercept treatment.

Conclusion:

Eyes with persistent intraretinal macular fluid had visual and anatomic response after changing from ranibizumab to aflibercept treatment.     

玻璃体内注射雷珠单抗对渗出型年龄相关性黄斑变性患者的疗效

目的　探讨玻璃体内注射雷珠单抗对渗出型年龄相关性黄斑变性（age-related maculardegeneration,AMD）患者的疗效。方法　选取我院2010年2月至2015年5月收治的33例（33眼）渗出型AMD患者,均给予玻璃体内注射雷珠单抗（Ranibizumab）治疗。采用国际标准对数视力表检查患者手术前后的最佳矫正视力;比较患者术前、术后眼动脉、视网膜中央动脉、睫状动脉血流动力学参数的差异性;采用荧光素眼底血管造影测量并计算患者手术前后脉络膜新生血管（choroidal neovascularization,CNV）荧光素渗漏面积变化。结果　术后1周最佳矫正视力提高至0.29±0.18,与术前（0.16±0.15）比较,差异有统计学意义（P=0.002）。术后7 d,患者CNV荧光素渗漏面积为（8.48±6.13）mm²,较术前（11.39±6.12）mm²明显减小,差异有统计学意义（P=0.029）。注射眼术前,术后1周、4 周眼动脉、视网膜中央动脉、大脑后动脉的收缩期峰值流速、舒张末期血流速度及阻力指数、搏动指数差异均无统计学意义（均为P＞0.05）。结论　玻璃体内注射雷珠单抗治疗渗出型AMD可有效提高患者视力,减少CNV渗漏,且对患者眼血流动力学影响不显著,安全有效。     

Treatment of exudative age-related macular degeneration

I PROPHYLACTIC TREATMENT: We followed 75 eyes contralateral to eyes with exudative age-related macular degeneration (AMD), using indocyanine green angiography (IA), for more than one year. Hyperfluorescent areas in the late phase of IA were seen in 19 eyes at the initial examination, and in 25 eyes during follow-up. Exudative AMD developed in 9 of the 25 eyes. Using timetable analysis, we estimated that 11% of these 27 eyes developed AMD within one year and 55% within three years. The hyperfluorescent areas seen on IA appeared to be latent choroidal neovascularization (CNV) under the retinal pigment epithelium. We propose that photocoagulation aimed at hyperfluorescent areas should be considered in such cases. We performed prophylactic laser photocoagulation in 21 eyes, which were then followed up for at least six months. These eyes all had 10 or more serous drusen within 1,500 microns of the fovea and did not show hyperfluorescence, suggesting latent CNV in the late phase of IA. The majority or a small fraction of the serous drusen disappeared in 48% and 18% of the 21 eyes, respectively. CNV appeared adjacent to the laser scar in one eye (5%). Judging from these results, it is important to establish a method of definitively abolishing drusen and preventing the development of CNV. II TREATMENT OF CNV: Of 229 eyes which showed occult CNV in fluorescein angiography (FA), 124 eyes (54%) showed classic CNV outside the fovea on IA. One hundred and two of the 124 eyes (45%) underwent laser photocoagulation. We evaluated indocyanine green guided laser photocoagulation of extrafoveal CNV in 139 eyes. The success rate was 81% at 3 months after laser photocoagulation. This was estimated using timetable analyses to have decreased to 78% at one year and 71% at three years. Eighty percent of successfully treated eyes showed maintained or improved visual acuity. These results did not differ significantly from those obtained with laser photocoagulation based on FA findings. When classic CNV is not detected on FA, IA is indicated and if classic CNV is detected outside the fovea, photocoagulation should be performed aggressively. We compared the histological findings of removed subfoveal CNV with the IA findings prior to removal. IA findings of CNV before removal were divided into four types. Types I and II showed numerous vascular lumina in von Willebrand factor staining. Prominent proliferation in types I and II was demonstrated with Ki-67. Vascular endothelial growth factor (VEGF) showed strong staining in types I, II and III. Therefore, CNV in eyes with types I, II and III, and especially type I, requires urgent treatment. We compared visual outcomes one year after treatment between 52 eyes that underwent removal and 56 eyes that underwent laser photocoagulation of subfoveal CNV. When CNV size was one disc diameter or less, mean visual acuity, the percentage of eyes with improved vision and with a visual acuity of 0.1 or more, was significantly greater in operated eyes than in coagulated eyes. Removal is therefore superior to photocoagulation in subfoveal CNV of one disc diameter or less in size. We evaluated preoperative factors influencing the best corrected visual acuity at least six months after removal of subfoveal CNV in 67 eyes. Factors influencing the best corrected visual acuity were IA findings, feeder vessel ingrowth sites and CNV sizes. Good indications for removal included types I, II and III IA findings, extra foveal location feeder vessel ingrowth sites, and small CNV. III LOW VISION CARE: We performed reading tests using the MN read J chart for 90 eyes with the scar stage of CNV. Reading speed profiles of the 90 eyes were classified into two groups: 48 eyes showing a plateau with a relatively constant reading rate at the maximum level; and 42 eyes showing steadily increasing reading rate without a plateau. Eyes without a plateau had worse visual acuity, worse reading acuity, and slower reading speed. We evaluated newspaper reading performance by comparing conventional versus new methods based on the critical print size of the MN read J chart. Magnification power based on the critical print size were similar to those finally chosen as the best aid by the patients. On the other hand, magnification power was lower when conventional methods were used. The critical print size of the MN Read J chart appears to be valuable for determining low vision aids which facilitate reading by AMD patients.     

渗出型年龄相关性黄斑变性治疗进展

年龄相关性黄斑变性(age-related macular degeneration,AMD)是老年人致盲和严重视力丧失的主要原因之一.AMD有萎缩型和渗出型2种,渗出型AMD的主要特征为脉络膜新生血管形成.目前,针对脉络膜新生血管的有效治疗措施主要包括激光治疗、放射疗法、糖皮质激素和抗新生血管因子玻璃体腔内注射、外科手术等.临床试验和病例报道广泛证实了这些方法的有效性.本文综述了治疗渗出型AMD的主要药物和方法的进展.     

Long-term outcomes of ranibizumab treatment in neovascular age-related macular degeneration

AIM: To investigate 3-year results in our neovascular age related macular degeneration (NV-AMD) patients treated with ranibizumab. METHODS: Retrospective study. Visual acuity (VA), a full biomicroscopic examination (anterior segment and fundus), and optical coherence tomography (OCT) findings were noted at every visit. All patients were followed monthly. The VA values for the visits closest to 12, 24, and 36mo were analysed. 101 eyes of 73 patients were enrolled. According to the initial VA, the patients were divided three groups: initial VA ≤35 (Group 1), 36-54 (Group 2), and ≥55 letters (Group 3). After three loading doses of 0.5 mg ranibizumab if retreatment was needed, again, 0.5 mg ranibizumab was administered RESULTS: Totally 57 of the 101 eyes were from males and 44 were from females. The average age was 75.1 years. The difference on the changes of VA among three groups at 24 and 36mo were statistically significant (P=0.02 and 0.001 respectively). At the end of the 36-month follow-up the VA increase in Group 2 was significant (P=0.001). At the 12, 24, and 36mo visits most of the eyes showed no VA loss and most of these eyes were in Group 1. The average number of injections administered was 7.3 and the average number of visits was 23.9 during the follow-up. CONCLUSION: VA improvement was significant in those with mild initial VA (36-54 letters). Most eyes showed no VA loss regardless of the initial VA. No correlation between the final VA and the average number of injections.     

雷珠单抗治疗重度视力损害渗出型年龄相关性黄斑变性患者的疗效观察

目的观察玻璃体腔注射雷珠单抗治疗重度视力损害渗出型年龄相关性黄斑变性(AMD)患者的疗效。方法回顾性分析在我院确诊为渗出型AMD、最佳矫正视力(BCVA)<0.05并接受雷珠单抗玻璃体腔注射的46例患者(47只眼)的临床资料。所有患者均行玻璃体腔注射雷珠单抗治疗,治疗后随访1~8个月,平均随访(4.09±2.25)个月。对比分析玻璃体腔注射雷珠单抗治疗前后BCVA、黄斑中心视网膜厚度(CRT)、病变最厚处视网膜厚度(MRT)的变化及不良反应的发生情况。结果至末次随访时,47只眼中,视力提高29只眼,占61.7%;视力稳定15只眼,占31.9%;视力下降3只眼,占6.4%。治疗后,平均CRT由治疗前的(301.30±84.57)μm降低为(211.27±87.03)μm;与治疗前相比,平均CRT下降(90.03±33.99)μm,差异有统计学意义(t=4.336,P<0.01);MRT由(529.04±174.63)μm降低为(421.86±95.78)μm;与治疗前相比,平均MRT下降(107.17±42.46)μm,差异有统计学意义(t=3.984,P<0.01)。结论雷珠单抗治疗重度视力损害渗出型AMD患者具有较好的疗效。