Comparison between ranibizumab and aflibercept for macular edema associated with central retinal vein occlusion

Purpose

We compared the efficacy of bimonthly intravitreal injections of ranibizumab (IVR) with that of bimonthly intravitreal injections of aflibercept (IVA) in two prospective, consecutive groups of patients with macular edema (ME) secondary to central retinal vein occlusion (CRVO).

Patients and Methods

Eyes with ME after CRVO received either bimonthly IVR (ranibizumab group; n = 13) or IVA (aflibercept group; n = 13) injections and were followed monthly for 6 months. Three patients in the ranibizumab group and two in the aflibercept group were lost to follow-up and excluded from the study. The best-corrected visual acuity (BCVA), central foveal thickness (CFT) on optical coherence tomography, and aqueous vascular endothelial growth factor (VEGF) concentrations were evaluated before and after treatment.

Results

From baseline to month 6, significant improvements occurred in mean logMAR BCVA (ranibizumab group: 0.78–0.47; p < 0.05; aflibercept group: 0.74–0.54; p < 0.05) and mean CFT (ranibizumab group: 685–311 µm; p < 0.05; aflibercept group: 695–230 µm; p < 0.05). Fluctuations in CFT were seen at months 2, 4, and 6 in the ranibizumab group. Mean aqueous VEGF concentration decreased from baseline to month 2 in the ranibizumab group (509.9–348.2 pg/ml) and aflibercept group (412.1 pg/ml to undetectable limits in eight of 11 eyes and to 13.6, 15.6, and 24.1 pg/ml in the other three eyes, respectively).

Conclusions

There was no significant improvement of visual acuity in one group compared with another; VEGF may not be completely neutralized by bimonthly injections of ranibizumab.

     

Bimonthly injections of ranibizumab for age-related macular degeneration

Purpose

To evaluate the efficacy of bimonthly intravitreal injections of ranibizumab for age-related macular degeneration (AMD) and polypoidal choroidal vasculopathy (PCV) in a pilot study.

Methods

This study was a prospective, interventional case series. Thirty eyes of 30 patients received prospectively at least three bimonthly intravitreal injections of ranibizumab (0.5 mg/0.05 ml) without loading doses. The best-corrected visual acuity (BCVA) and the central retinal subfield thickness (CRST) were measured before and monthly after the injections.

Results

Twenty-eight patients received the three planned injections; one patient refused the third injection, one patient did not receive the third injection because blood pressure was raised, and one patient received a rescue injection at month 5 because of increased retinal thickness. The mean logarithm of the minimum angle of resolution (logMAR) BCVA was 0.44?±?0.37 before treatment and significantly improved to 0.25?±?0.34 at month 6 (p?p?p?=?0.005). The mean CRST was 360?±?110.8 μm before treatment and decreased significantly to 249?±?57.0 μm at month 12 (p?=?0.025).

Conclusions

Bimonthly injections of ranibizumab may be effective for treating AMD and PCV.     

Evaluation of plasma vascular endothelial growth factor levels after intravitreal injection of ranibizumab and aflibercept for exudative age-related macular degeneration

Background

To evaluate the plasma vascular endothelial growth factor (VEGF) levels after one intravitreal injection of aflibercept or ranibizumab in patients with exudative age-related macular degeneration (AMD).

Methods

Twenty-four Japanese with exudative AMD, polypoidal choroidal vasculopathy, and retinal angiomatous proliferation were included. Fourteen patients received an intravitreal injection of aflibercept, and ten patients received an intravitreal injection of ranibizumab. Plasma VEGF levels were evaluated within 7 days before the intravitreal injections and 1 day, 1 week, and 1 month after the intravitreal injection.

Results

In the ranibizumab group, the mean plasma VEGF levels were 245.7?±?233.4 pg/ml before the injection, 246.6?±?304.8 pg/ml after 1 day, 217.8?±?212.9 pg/ml after 1 week, and 260.0?±?290.1 pg/ml after 1 month. The plasma VEGF levels did not decrease significantly in patients in the ranibizumab group at any time point. In the aflibercept group, the mean plasma VEGF levels were 280.0?±?170.3 pg/ml before the intravitreal injection and 8.2?±?12.9 pg/ml after 1 day, 9.1?±?9.1 pg/ml after 1 week, and 41.9?±?41.4 pg/ml after 1 month (p?Conclusion Intravitreally injected aflibercept reduced plasma VEGF over at least 1 month. In contrast, intravitreal injection of ranibizumab did not cause a significant reduction in the plasma VEGF levels.     

Impact of injection techniques on intraocular pressure (IOP) increase after intravitreal ranibizumab application

Purpose

To examine the influence of different intravitreous injection techniques on the short-term intraocular pressure (IOP) in patients with exudative age-related macular degeneration (AMD) receiving 0.05 ml ranibizumab (Lucentis®) in the supine position.

Methods

Forty-five eyes (45 patients, 16 male, 29 female, mean age: 78 years) received intravitreal ranibizumab injections for treatment of exudative AMD (0.05 ml?=?0.5 mg). A total of 31 patients received a standard straight scleral incision, and 14 were injected using the tunneled sclera technique. IOP was measured by Schiøtz tonometry immediately pre-and postoperatively, and the amount of subconjunctival reflux was documented using a semi-quantitative scale. Twenty-three eyes were phakic, and the remaining 22 were pseudophakic. No history of glaucoma was present. The Wilcoxon matched-pairs test was used for comparisons.

Results

The mean preoperative IOP was 22.4?±?5.5 mmHg in the supine position. Immediately after the injection, the IOP increased to 47.9?±?15.1 (range 23–82). The mean difference between preoperative IOP and immediately after the injection was 25.5?±?13.6 mmHg. The mean IOP increase in eyes receiving a standard straight scleral incision was 21.9?±?14.2 mmHg (median 22.3) versus 33.5?±?7.2 mmHg (median 34.7) in the tunneled scleral incision group (p?=?0.001).

Conclusions

IOP increased significantly in a considerable number of patients after receiving 0.05-ml intravitreal ranibizumab injections. This increase was dependent on the intravitreal injection technique and was significantly higher if a tunneled scleral injection was performed.     

Two-year results of reduced-fluence photodynamic therapy combined with intravitreal ranibizumab for typical age-related macular degeneration and polypoidal choroidal vasculopathy

Purpose

To report the 2-year results of reduced-fluence photodynamic therapy (RF-PDT) combined with intravitreal ranibizumab (IVR) for typical age-related macular degeneration (AMD) and polypoidal choroidal vasculopathy (PCV).

Methods

Twenty-four previously untreated eyes of 23 AMD patients with decimal best-corrected visual acuity (BCVA) of less than 0.7 received the combined therapy, followed by retreatments as needed over the subsequent 2 years. When the BCVA was better than or equal to 0.7, only 3 monthly IVR injections were performed during the retreatment.

Results

The BCVAs were maintained in 7 of 10 typical AMD eyes and in 13 of 14 PCV eyes at month 24. The mean BCVA improved in the PCV group (P < 0.05) but not in the typical AMD group. The central foveal thickness decreased in both groups (P < 0.01, P < 0.001). The mean numbers of the total PDT and IVR injections were 1.8 and 7.2 in the typical AMD group and 1.8 and 6.4 in the PCV group.

Conclusion

After RF-PDT combined therapy with administration of retreatments as needed that consisted of either 3 IVR injections alone or combined therapy, the BCVA was maintained in typical AMD and improved in PCV during a 2-year follow-up period.     

Retreatment by series of three intravitreal injections of ranibizumab in neovascular age-related macular degeneration: long-term outcomes

Background

The purpose of this study was to analyze the results of a retreatment regimen using a series of three monthly intravitreal ranibizumab injections (IVR), instead of one injection, and to determine if this treatment scheme can safely reduce the number of injections and the number of visits compared to the widely used PrONTO study retreatment protocol.

Methods

>Sixty-six eyes of 60 patients with exudative age-related macular degeneration (AMD) were included. The mean follow-up period was 27 months (range, 11–48 months). The mean age of the patients was 79 years (range, 65–93 years). All patients received three initial IVRs, and were retreated with a new series of three monthly IVRs when needed. The retreatment criteria were: visual loss of ≥5 ETDRS letters and/or signs of retinal exudation on OCT, new macular hemorrhage, expansion of new vessels. Follow-up visits were conducted 1 month after the last IVR of each series, and renewed on a monthly basis when no retreatment was required. Each visit included a comprehensive ophthalmological examination with BCVA measurement and OCT examination.

Results

Mean VA did not improve during follow-up (53.18 letters at the initial visit versus 54.18 at the last visit, p?>?0.05). However, VA stabilized or improved in 66.6 % of the eyes. A gain of ≥15 letters was observed in 28.8 % of eyes. On average, over 2 years, the number of IVRs was five per year, and the number of follow-up visits was four per year.

Conclusion

Even if no gain in VA is observed after 2 years, this treatment regimen reduces the number of IVRs and control visits. The proportion of patients with a VA gain of three lines or more was smaller than the one reported in the original PrONTO study, but higher than the rates reported in other studies implementing the PrONTO recommendations in everyday practice. The benefit of the three IVR retreatment scheme should be prospectively studied and compared to the PRN regimen.     

Two-year results of combined intravitreal ranibizumab and photodynamic therapy for polypoidal choroidal vasculopathy

Background

To clarify the efficacy of combined therapy with intravitreal ranibizumab injections and photodynamic therapy (PDT) in patients with symptomatic polypoidal choroidal vasculopathy (PCV).

Methods

We retrospectively reviewed 57 treatment-naïve eyes of 57 patients. Thirty-two patients were treated with standard fluence PDT (PDT group), and 25 patients were treated with three consecutive monthly intravitreal injections of ranibizumab and standard fluence PDT (ranibizumab plus PDT group). All patients were followed for at least 24 months.

Results

In the ranibizumab plus PDT group, the mean best-corrected visual acuity (BCVA) levels of decimal (logMAR equivalent) significantly improved from 0.30 (0.52) at baseline to 0.55 (0.26) at 24 months (P?<?0.001). In the PDT group, the BCVA levels stabilized from 0.26 (0.58) at baseline to 0.25 (0.60) at 24 months. The mean changes in the BCVA in the ranibizumab plus PDT group and the PDT group were improvement of 2.63 lines and decline of 0.16 lines respectively (P?=?0.010). The mean number of PDTs at 24 months in the ranibizumab plus PDT group and the PDT group were 1.4 and 2.6 respectively. Increased subretinal hemorrhages were seen in eight (18.0 %) eyes, all of which were belonging to the PDT group.

Conclusions

Combined intravitreal ranibizumab and PDT was significantly more effective in maintaining and improving VA for PCV patients compared with PDT monotherapy over 24 months.     

Clinical outcomes after switching treatment from intravitreal ranibizumab to aflibercept in neovascular age-related macular degeneration

Purpose

To describe the treatment response to aflibercept in patients with exudative age-related macular degeneration that showed insufficient or diminishing treatment effects under ranibizumab.

Methods

From December 2012 till June 2013 all patients receiving intravitreal injections of aflibercept after previous treatment with ranibizumab were collected in a database and retrospectively reviewed. Clinical data such as visual acuity or central subfield retinal thickness on optical coherence tomography (OCT) scans were analyzed for the time frame before, during, and shortly after the aflibercept injections. Of particular interest was the comparison of clinical features under ongoing ranibizumab treatment to the time during aflibercept treatment.

Results

Seventy-one eyes of 65 patients were included in the study. All eyes had previous ranibizumab injections in their medical history, the average number of which was nine (range 3-43). For the total group the mean visual acuity (VA) before the first ranibizumab injection was 0.54 logMAR, and after the last ranibizumab injection was 0.57 logMAR. Mean VA changed from 0.47 logMAR before the first aflibercept injection to 0.25 logMAR after the last aflibercept injection. Central subfield retinal thickness (CSRT) on OCT changed from a mean of 417.28 μm to 349.52 μm under ranibizumab treatment and from 338.76 μm to 272.00 μm under aflibercept treatment. Interestingly, 33 % of cases that did not show a functional improvement under ranibizumab therapy gained visual acuity after aflibercept treatment.

Conclusion

Aflibercept appears to be an effective choice for patients with neovascular age-related macular degeneration who were resistant to previous therapy of ranibizumab. The longevity of this effect still remains questionable.     

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

Background

Intravitreal injections of ranibizumab are the standard of care for neovascular age-related macular degeneration (AMD). In clinical trials, comparable efficacy has been shown for either monthly injections or as needed injections upon monthly controls. Unlike in trial settings, treatment in clinical routine is often delayed by complex approval procedures of health insurance and limited short-term surgical capacities.

Methods

Eighty-nine patients with neovascular AMD were followed for 12 months. Early treatment diabetic retinopathy study (ETDRS) visual acuity (VA), Radner reading VA and spectral domain optical coherence tomography were performed monthly, with additional fluorescein angiography if needed. After an initial loading phase of three consecutive monthly intravitreal injections with ranibizumab, re-injections were performed when recurrent activity of choroidal neovascularization (CNV) was detected.

Results

After an initial increase to a value of +5.0?±?11.87 ETDRS letters from baseline, VA constantly decreased over 12 months to a value of ?0.66?±?16.82 ETDRS letters below baseline. Central retinal thickness (CRT) decreased from a value of 438.1?±?191.4 μm at baseline to a value of 289.9?±?138.6 μm after initial therapy and stabilized at a value of 322.4?±?199.5 μm. Loss of VA during latency between indication to treat and treatment was significantly greater than re-gain of VA after re-initiation of therapy (?2.2?±?5.0 versus 0.4?±?7.4 letters; p?=?0.046).

Conclusions

Latency between indication to treat and treatment is responsible for irreversible VA deterioration. A successful PRN treatment regimen for neovascular AMD requires immediate access to therapy after indication.     

Ranibizumab bei diabetischem Makulaödem

Background

Intravitreal anti-VEGF (vascular endothelial growth factor) therapy with ranibizumab has been shown to be an effective therapeutic option for foveal diabetic macular edema (DME). This prospective study evaluated the functional and morphological retinal changes after intravitreal ranibizumab treatment.

Material and methods

A consecutive prospective series of DME patients treated with intravitreal ranibizumab were examined before and after 3 and 6 months of intravitreal ranibizumab therapy. Best-corrected visual acuity (BCVA) according to the ETDRS protocol, retinal thickness in the macular area and central retinal thickness (CRT) measured with spectral-domain optical coherence tomography (SD-OCT) was determined. In addition, microperimetric functional macular mapping was determined before therapy and 4 weeks after the third injection.

Results

A total of 41 eyes from 33 patients were evaluated. During the 6-month observational period patients received a mean number of 5.2 injections. The mean BCVA increased significantly from 26?±?14 to 33?±?13 letters 4 weeks after the third injection and to 34?±?14 letters 6 months after starting the treatment. The mean CRT decreased significantly from 509?±?147 µm to 385?±?121 µm after the third injection and to 383?±?110 µm after 6 months. After 3 injections, the thickness of the most prominent central retinal area was less than 445 µm in 68.3% of patients and after a further 3 months of treatment in 78.0%.

Conclusion

The presented data demonstrate that intravitreal ranibizumab is effective for DME in everyday clinical practice and results are comparable to those of registration trials. After three initial injections significant structural and functional improvements were observed in a considerable number of patients.     

Prospective study evaluating the predictability of need for retreatment with intravitreal ranibizumab for age-related macular degeneration

Purpose

To investigate the rhythm and predictability of the need for retreatment with intravitreal injections of ranibizumab for neovascular age-related macular degeneration (nAMD).

Methods

This prospective study enrolled 39 patients with treatment-naïve nAMD. After three loading doses of intravitreal ranibizumab, patients underwent an intensified follow-up for 12 months (initially weekly, then with stepwise increases to every 2 weeks and to monthly after each injection). Patients were retreated on an as-needed basis if any fluid or increased central retinal thickness (CRT) (>50μm) was found on spectral domain optical coherence tomography (OCT). Statistical analysis included patients who received at least two retreatments (five injections).

Results

A mean of 7.5 injections (range 0–12) were given between months 3 and 15. The mean visual acuity increased by 13.1 and 12.6 ETDRS letters at months 12 and 15 respectively. Two or more injection–retreatment intervals were found in 31 patients. The variability of their intra-individual intervals up to 14 weeks was small (SD 0–2.13 weeks), revealing a high regularity of the retreatment rhythm. The SD was correlated with the mean interval duration (r?=?0.89, p?<?0.001). The first interval was a good predictor of the following intervals (regression coefficient =0.81). One retreatment criterion was stable in 97 % of patients (cysts or subretinal fluid).

Conclusion

The results of this study demonstrate a high intra-individual predictability of retreatment need with ranibizumab injections for nAMD. These findings may be helpful for developing individualized treatment plans for maintained suppression of disease activity with a minimum of injections and visits.     

High-dose ranibizumab therapy for vascularized pigment epithelial detachment

Purpose

The conventional dose of anti-vascular endothelial growth factor treatment may slowly reduce the subretinal fluid and height of a vascularized pigment epithelial detachment (vPED), but rarely leads to its complete resolution. We report a dramatic outcome involving a high dose (2 mg) of ranibizumab for treating vPED.

Methods

This report describes three eyes with vPED that received 2 mg in 0.05 ml of ranibizumab injections on a monthly basis and were followed prospectively. Each patient received a complete ocular examination, including best-corrected standardized ETDRS testing, fundus photography (FP), fluorescein angiography (FA), optical coherent tomography (OCT), and indocyanine-green angiography at baseline. ETDRS and OCT testing were repeated monthly, while FP and FA were performed every 3 months.

Results

Following a single intravitreal injection of 2 mg ranibizumab, there was rapid resolution of the subretinal fluid, haemorrhage, exudates, and flattening of the vPED within 10 days for Case 1, and within 1 month for Case 2 and Case 3.

Conclusion

Rapid and dramatic decrease in the exudative changes and collapse of the vPED may develop after a single injection of high-dose (2 mg) ranibizumab in certain eyes with a vPED. The improvement was maintained with additional monthly injections to 12 months.     

Early neovascular bridging of choroidal neovascularization after ranibizumab treatment

Background

To report three cases of early choroidal neovascularization (CNV) bridging after ranibizumab treatment.

Methods

Three patients with two separated foci of CNV secondary to age-related macular degeneration (ARMD), pathologic myopia and multifocal choroiditis were treated with monthly injections of ranibizumab por a period of 3 months.

Results

All three cases showed early coalescence across the fovea of the two neovascular foci, already 1 month after the first ranibizumab injection. Best-corrected visual acuity (BCVA) decreased in the three cases more than 20 letters due to early foveal involvement.

Conclusions

Two different foci of CNV show a great tendency to decrease patients' vision because of neovascular bridging with foveal implication.     

Structural and functional assessment after intravitreal injection of ranibizumab in diabetic macular edema

Purpose

To evaluate structure and function improvement in central retina by optical coherence tomography (OCT) and multifocal electroretinography (mf-ERG) in diabetic macular edema (DME) patients after intravitreal injection of ranibizumab (IVR) treatment.

Methods

Twenty-seven eyes in 27 patients with DME received three consecutive monthly injections of IVR (0.05 ml, 10 mg/ml) and as needed thereafter. The clinical parameters of best-corrected visual acuity (BCVA), central foveal thickness (CFT) and mf-ERG were monitored for 6 months before and after IVR. The findings at baseline, 1, 3 and 6 months were analyzed. Correlation and regression analyses were performed on BCVA, CFT, mf-ERG amplitude and implicit time of the N1 and P1 waves.

Results

IVR significantly improved visual acuity from the beginning of the treatment (P < 0.05). There were significant decreases in the CFT compared with the baseline after IVR (P < 0.05). The mean amplitude of P1 and N1 in the central ring at all examinations increased significantly compared with the baseline (P < 0.05). The mean P1 and N1 implicit times in the central ring were shortened, but not significantly (P > 0.05). There were significant correlations of BCVA with CFT, P1 and N1 amplitudes in the central retina (P < 0.05).

Conclusion

In addition to the improvement in BCVA and the reduction in CFT, IVR improved macular retinal function, as assessed by mf-ERG, in diabetic eyes. The combination of OCT and mf-ERG for macular evaluation may better assess DME.

     

Effect of aflibercept in insufficient responders to prior anti-VEGF therapy in neovascular AMD

Purpose

Evaluation of three aflibercept injections at 4-week intervals in patients with neovascular AMD showing an “insufficient anatomic response” to prior anti-VEGF therapy with ranibizumab or bevacizumab.

Methods

The retrospective analysis included 96 eyes that had received at least three intravitreal 0.5 mg ranibizumab or 1.25 mg bevacizumab injections over a period of no more than 4 months prior to switching to aflibercept. In addition, the selected eyes had to have evidence of persisting or increasing sub- or intraretinal fluid, observed in optical coherence tomography (OCT). All patients received a loading dose of three intravitreal 2 mg aflibercept injections at 4-week intervals. Evaluation included central retinal thickness (CRT) and maximum pigment epithelium (PED) height measured by spectral domain OCT and best-corrected visual acuity (BCVA) prior to the switch of therapy and 4 weeks after the third aflibercept injection.

Results

A significant reduction of mean CRT (?39 μm; p?p?p?=?0.061). The further analysis did not show any correlation of the change in CRT, maximum PED, and BCVA with the number of prior anti-VEGF treatments.

Conclusion

Retinal edema and PEDs regressed significantly after switching to aflibercept in patients insufficiently responding to prior therapy with ranibizumab or bevacizumab. No correlation could be found with regard to the number of prior treatments.     

Multiphasic changes in systemic VEGF following intravitreal injections of ranibizumab in a child

Purpose

To investigate whether intravitreal ranibizumab injections administered to a child alter systemic plasma levels of total and free VEGF 165.

Methods

A 9-year-old child sustained a choroidal rupture from blunt trauma. He subsequently developed a secondary choroidal neovascular membrane, which was treated with five ranibizumab injections over a period of 8 months. Peripheral venous blood samples were taken at each visit over a period of 12 months and plasma was extracted. Plasma VEGF 165 levels were determined using enzyme-linked immunosorbent assay and were assayed both pre- and post-immunodepletion to remove complexed VEGF.

Results

Plasma VEGF 165 levels proved labile following intravitreal injection of ranibizumab. Levels increased by 30% above baseline following the first intravitreal ranibizumab injection, but then returned to baseline despite two subsequent injections. There was then a rebound increase of 67% in total plasma VEGF levels following a further injection, which remained above baseline for 12 weeks despite two further intravitreal ranibizumab injections. Baseline levels were re-attained 26 weeks after the final injection.

Conclusions

These results suggest intravitreal ranibizumab injections can cause significant, multiphasic changes in systemic VEGF levels. This may be of particular clinical significance in children as VEGF is known to be vital in the development of major organs, in addition to its role in the maintenance of normal organ function in adults.     

Intravitreal ranibizumab in retinal macroaneurysm

Purpose

To present the effect of intravitreal ranibizumab (Lucentis®) therapy in a patient suffering from retinal macroaneurysm.

Methods

Case report. An 82-year-old female patient was diagnosed with retinal macroaneurysm of the inferior temporal artery with macular edema. Functional and morphological data at baseline and at 4 weeks, 3 months, and 5 months after the initiation of therapy with two intravitreal ranibizumab (Lucentis®) injections followed by focal argon laser coagulation surrounding the retinal macroaneurysm are presented.

Results

Best-corrected visual acuity improved from 20/50 at baseline to 20/20 at 3-month follow-up and maintained stable at 20/25 through 5-month follow-up. Central retinal thickness measured by optical coherence tomography decreased from 510 µm at baseline to 148 µm at 5-month follow-up. Fluorescein angiography demonstrated closure of the retinal macroaneurysm at 6-week follow-up. No ocular or systemic side effects were detected.

Conclusions

Intravitreal ranibizumab (Lucentis®) therapy may close the retinal macroaneurysm leading to resolution of the associated macular edema and consequently visual improvement. To our knowledge, this is the first case of a retinal macroaneurysm benefiting from treatment with intravitreal ranibizumab (Lucentis®). The observed results warrant further investigation.     

A comparison of responses to intravitreal bevacizumab,ranibizumab, or aflibercept injections for neovascular age-related macular degeneration

Purpose

To compare the responses of intravitreal injections of bevacizumab, ranibizumab, or aflibercept for the treatment of neovascular age-related macular degeneration (nAMD).

Methods

This retrospective study examined 232 eyes of 232 patients who received intravitreal anti-vascular endothelial growth factor (VEGF) injections due to treatment-naïve nAMD. All patients, who were followed-up for at least 1 year, were treated with intravitreal injections monthly until 3 months, and then as needed. We evaluated the effects of intravitreal injections for treatment of nAMD using the central macular thickness (CMT), subretinal fluid (SRF), pigment epithelial detachment (PED) size, and best-corrected visual acuity (BCVA).

Results

CMT, SRF, PED size, and BCVA (LogMAR) were significantly decreased after treatment with all three anti-VEGF agents. Overall, the bevacizumab, ranibizumab, and aflibercept treatments showed no significant differences in their responses. However, the aflibercept injections decreased PED size more quickly than bevacizumab injections (P = 0.034).

Conclusions

Bevacizumab, ranibizumab, and aflibercept injections are effective treatments for nAMD and have similar responses, although the number of injections of aflibercept was fewer than other anti-VEGF agents. In addition, aflibercept injections may be a better choice than other anti-VEGF agents for cases of severe increases in PED height.

     

Intravitreal ranibizumab treatment of retinal angiomatous proliferation

Purpose: To determine the efficacy of intravitreal injections of ranibizumab in the treatment of retinal angiomatous proliferation (RAP) in neovascular age‐related macular degeneration. Methods: Retrospective, consecutive case series of 26 eyes (26 patients) treated with intravitreal injections of 0.5 mg ranibizumab for RAP. Patients received intravitreal injections at monthly intervals during upload phase for a 3‐month period. Results: Mean visual acuity before treatment was 0.75 ± 0.38logMAR (mean ± SD, n = 26). In the upload phase, mean visual acuity improved 4 weeks after the initial injection to 0.6 ± 0.37logMAR (n = 26) and to 0.53 ± 0.34logMAR (n = 26) 4 weeks after the third monthly intravitreal injection of ranibizumab. The mean optical coherence tomography (OCT) central foveal thickness reduced from 345 ± 55 μm at baseline to 215 ± 87 μm at 3 months. In the maintenance phase, mean visual acuity after 6 months was 0.66 ± 0.38logMAR (n = 12) and 0.7 ± 0.37logMAR after 9 months (n = 6). The mean OCT central foveal thickness was 259 ± 59 μm (n = 13) at 6 months and 280 ± 127 μm (n = 6) at nine‐month follow‐up. Conclusion: Intravitreal ranibizumab resulted in an improvement of visual acuity 4 weeks after the first injection but was more pronounced after 3 months. A reduction in leakage and OCT central foveal thickness was seen 3 months after the commencement of treatment.     

Retinal function in eyes with proliferative diabetic retinopathy treated with intravitreal ranibizumab and multispot laser panretinal photocoagulation

Purpose

To compare retinal function changes in eyes with proliferative diabetic retinopathy (PDR) after intravitreal ranibizumab (IVR), combined or not with conventional (ETDRS) or multispot laser panretinal (PASCAL) photocoagulation (PRP).

Methods

This study included laser-naive PDR patients that required PRP. Eyes were randomly and prospectively assigned to receive IVR or IVR combined with PASCAL or EDTRS. PRP was performed at baseline in 1 (PASCAL) or 2 (ETDRS) sessions. In eyes with macular edema, macular short pulse grid laser was associated with IVR at baseline and IVR was repeated monthly or quarterly if neovascularization was detected on angiography. Comprehensive ophthalmological evaluations, including SD-OCT, were performed at baseline and every 4 weeks after treatment. Full-field electroretinography (ERG: extended ISCEV standard) was performed at baseline and at 12, 24 and 48 weeks.

Results

IVR?=?13, PASCAL?=?15 and ETDRS?=?15 eyes finished 48-week follow-up. There was a statistically significant BCVA improvement of 0.1–0.3 logMAR in all groups, and fluorescein angiography leakage area (FLA) reduced in 56%, 73%, and 73% from baseline for ETDRS, IVR and PASCAL, respectively, up to 48 weeks without significant differences between groups (p?>?0.05). A significant a- and b-wave amplitudes reduction was observed for dark- and light-adapted ERG for ETDRS and PASCAL, but only minor dark-adapted b-wave reduction was found for IVR, up to 48 weeks. As an example, at week 48, combined response b-wave amplitude reduced in 181.5?±?31.4 µV, 128.0?±?27.9 µV and 82.4?±?15.2 µV for ETDRS, PASCAL and IVR (p?<?0.05 each group), respectively. No significant difference was observed between ETDRS and PASCAL for any ERG parameter.

Conclusions

IVR combined with single or multiple spot PRP causes similar retinal function impairment during 48 weeks of observation, while IVR alone seems to be similarly effective controlling FLA without changing retinal function.