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Andre J. Witkin, Richard S. Kaiser, Sunir Garg, Jason Hsu, Alok S. Bansal, Nikolas London, James Vander, Allen C. Ho; Biweekly Intravitreal Anti-VEGF Therapy for Non-Responders to Standard Regimen Anti-VEGF Therapy in Exudative Age-Related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2011;52(14):124.
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To describe 2 month visual acuity and optical coherence tomography (OCT) results of alternating biweekly ranibizumab/bevacizumab intravitreal injections in patients with exudative age-related macular degeneration (AMD) who have not responded to standard monthly injections of ranibizumab or bevacizumab.
Retrospective interventional case series. Inclusion criteria: patients with exudative AMD who have had either no change in or worsening visual acuity despite at least 3 monthly injections of either ranibizumab or bevacizumab. Exclusion criteria: Counting fingers or worse vision, patients with causes of decreased visual acuity other than exudative AMD. Patients who met inclusion criteria started receiving biweekly alternating ranibizumab/bevacizumab intravitreal injections; four injections were given over 8 weeks in all patients. Snellen visual acuity (converted to logMAR), central foveal thickness, and central foveal/lesion thicknesses were recorded at each visit. Central foveal thickness was the measurement at the fovea from the vitreoretinal interface to the end of the outer segments. Central foveal/lesion thickness was the measurement at the fovea from the vitreoretinal interface to Bruch's membrane. Two-tailed student’s t-tests were used for comparison of day 1 and week 8 data.
Thirteen eyes of 13 patients were included in the study. Patients had previously received a mean of 18.8 intravitreal injections of either ranibizumab or bevacizumab. On day 1 of starting biweekly injections, mean visual acuity was logMAR 0.667 (Snellen 20/93), mean central foveal thickness was 168um, and mean central foveal/lesion thickness was 425um. After 8 weeks of biweekly anti-VEGF injections, mean visual acuity improved to logMAR 0.467 (Snellen 20/57) (p = 0.003), which was statistically significant. Mean central foveal thickness decreased to 162um (p = 0.578), and mean central foveal/lesion thickness decreased to 368um (p = 0.124), however these changes were not statistically significant. There were no ocular or systemic adverse events during the study period.
Increasing frequency of intravitreal anti-VEGF therapy from monthly to biweekly in patients who have no visual acuity improvement with the standard regimen can be visually beneficial after 8 weeks of treatment, and may be an option for therapy in anti-VEGF "non-responders" with exudative AMD.
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