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Joao J Nassaralla, Joao J Nassaralla, Arthur Amaral Nassaralla; Intravitreal Aflibercept or Ranibizumab for Rubeosis Iridis – 1 year follow up. Invest. Ophthalmol. Vis. Sci. 2016;57(12):3039.
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© ARVO (1962-2015); The Authors (2016-present)
Aflibercept (Eylea®) and Ranibzumab (Lucentis®) are an anti-VEGF, but there are differences between the two drugs. Lucentis (R) is administered in the form of smaller molecules, which is thought to give R an advantage over Eylea (A) in its ability to penetrate the eye's halt abnormal blood vessel growth contributing to advanced macular degeneration and scarring that causes blindness. They may have a role in treating ocular disorders involving fibrovascular proliferation. To determine and compare whether intraocular A and R decreases rubeosis iridis (RI) in patients with neovascular glaucoma (NVG).
The study included 24 eyes with secondary NVG due to proliferative diabetic retinopathy (n=20) or ischemic vessel occlusion (n=4). 12 eyes received an intraocular injection (IOI) of 2.00 mg of A and 12 eyes 1.25mg R, from May 2013 to September 2015. IOI was performed in topical anaesthesia either in the anterior chamber (n=18) or via pars plana intravitreally (n=6). RI was investigated prospectively by iris biomicroscopy. An expanded informed consent with an off-label use waiver and explanation letter was reviewed with all patients. The follow up was performed 1, 3, 7, 15 days, 1, 6 months and 1, year after IOI.
Degree of RI decreased significantly (p<0.01) within 1 week after application of both drugs. The improvement was maintained for at least 4 weeks when was did panretinal photocoagulation (PRP). After 1 year only 3 eyes (2 A and 1 R) development reccurent RI, when was did more injection and more PRP. The two drugs are about equal in their effectiveness. An inflammatory response with fibrinous reaction and pseudohypopyon was observed in 1 case (with R) one day after surgery. The reaction persisted only 2 days.
The preliminary conclusion is that the two drugs are about equal in their effectiveness, but A or ranibizumab R, may provide an additional strategy to the treatment of R. Its long term effect and impact on NVG has to be determined. The number of patients in this pilot study was limited to make any specific treatment recommendations, but the favorable results suggest further study is needed. More studies are needed to evaluate the effect of this medication prior to clinical use.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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