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Joao J. Nassaralla, Jr., Belquiz A. Nassaralla; Intravitreal Bevacizumab versus Ranibizumab for Rubeosis Iridis. Invest. Ophthalmol. Vis. Sci. 2012;53(14):2952.
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Bevacizumab (Avastin) and Ranibzumab (Lucentis) are an anti-VEGF recombinant humanized monoclonal IgG1 antibody (both are produced by the same company _Genentech, based in San Francisco - CA - USA). But there are differences between the two drugs. Lucentis is administered in the form of smaller molecules, which is thought to give Lucentis an advantage over Avastin in its ability to penetrate the eye's retina and 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 bevacizumab and ranibzumab decreases RI in patients with neovascular glaucoma (NVG).
The study included 72 eyes of 64 patients with secondary NVG due to proliferative diabetic retinopathy (n=60) or ischemic vessel occlusion (n=12). All patients received an intraocular injection (IOI) of 1.25 mg of bevacizumab (IB) or ranibizumab (IR), from October 2005 to October 2010 at the Goiania Eye Institute. Intraocular injection was performed in topical anaesthesia either in the anterior chamber (n=58) or via pars plana intravitreally (n=14). 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 IOI was performed under sterile conditions in an operating theatre and was performed with proximetacaine (Anestalcon® - Alcon - Brazil) topical anesthesia and the injection did via pars plana.
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. The two drugs are about equal in their effectiveness. An inflammatory response with fibrinous reaction and pseudohypopyon was observed in three cases (2 bevacizumab and 1 with ranibizumab) one day after surgery. The reaction persisted only 2 days. However, that cost differences for those receiving treatment are major at about $40 per injection for Avastin and $2,000 per injection for Lucentis.
The preliminary conclusion is that the two drugs are about equal in their effectiveness, but. IB or IR may provide an additional strategy to the treatment of RI. Its long term effect and impact on NVG has to be determined. The number of patients in this pilot study was limited and the follow-up is too short to make any specific treatment recommendations, but the favorable short-term results suggest further study is needed. More studies are needed to evaluate the effect of this medication prior to clinical use.
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