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C. W. Leng, C. C. Cessna, S. N. Truong, D. G. Telander, S. Park, L. S. Morse; Treatment of Neovascular Age-Related Macular Degeneration With Ranibizumab After Bevacizumab: Effect on Persistent Macular Edema and Subretinal Fluid. Invest. Ophthalmol. Vis. Sci. 2007;48(13):3377.
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To evaluate the effect of intravitreal ranibizumab on persistent macular edema and/or subretinal fluid among patients with neovascular age-related macular degeneration (ARMD) previously treated with intravitreal bevacizumab.
Eight eyes of eight patients with neovascular ARMD with persistent macular edema and/or subretinal fluid seen on Stratus optical coherence tomography (OCT) after at least 3 monthly injections of intravitreal Bevacizumab (1.25 mg) were identified. These eyes were subsequently treated with at least 3 monthly intravitreal injections of Ranibizumab (0.5 mg). Best-corrected visual acuity (BCVA) and Stratus OCT imaging were compared before and after intravitreal Ranibizumab treatments.Patients who had undergone unsuccessful treatment with other modalities, including PDT, pegaptanib and/or IVTA in the past were included in this series. An average of 3.75 injections of bevacizumab (range 3-6) were administered every 4-8 weeks. These patients were found to have persistent cystoid macular edema and/or subretinal fluid after at least three injections of bevacizumab.Subsequently, all eight eyes received an average of 3.75 intravitreal injections of ranibizumab 0.5mg (range 3-5). Follow-up ranged from 6 to 11 months at the time of this abstract. Primary outcome was qualitative persistence of cystoid macular edema and/or subretinal fluid by Stratus OCT after treatment with ranibizumab. Secondary outcome was failure of ranibizumab to prevent worsening of BCVA.
All eight eyes received an average of 3.75 intravitreal injections of ranibizumab (range 3 to 5). Follow-up period ranged from 6 to 11 months. OCT findings remained unchanged in all eight patients after treatment with ranibizumab with persistence of subretinal fluid and/or cystoid macular edema. BCVA worsened in three patients and remained relatively unchanged in five.
Eyes with neovascular AMD with persistent cystoid macular edema and/or subretinal fluid after treatment with intravitreal bevacizumab do not appear to have any further improvement when treatment is changed to intravitreal ranibizumab.
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