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Marc H. Levin, Molly R. Nadelson, Ali Zaidi, Albert M. Maguire, Alexander J. Brucker; Biweekly Intravitreal Injections of Alternating Ranibizumab and Bevacizumab for Persistent Occult Choroidal Neovascularization. Invest. Ophthalmol. Vis. Sci. 2011;52(14):5651.
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To describe our experience with biweekly intravitreal injections of vascular endothelial growth factor inhibitors in patients with exudative age-related macular degeneration resistant to monthly dosing.
Retrospective chart review of six patients with choroidal neovascularization who were treated with biweekly intravitreal injections of alternating ranibizumab and bevacizumab. Patients were initially treated using a standard treatment protocol. After evidence of persistent fluid on optical coherence tomography or leakage on fluorescein angiography, patients received biweekly injections for two to three months. Treatment response was evaluated by fluorescein angiography and optical coherence tomography.
In four patients, there was no evidence of treatment success during or after the treatment period. A fifth patient showed improvement of a pigment epithelial detachment and subretinal fluid with slight improvement of visual acuity six weeks after final biweekly injection. In the sixth patient, a pigment epithelial detachment resolved promptly, but visual acuity did not improve.
In these patients with occult choroidal neovascularization who failed to respond to standard monthly vascular endothelial growth factor inhibitors injections, biweekly treatment did not appear to provide significant clinical benefit. Prospective studies of increased frequency intravitreal injections in patients with recalcitrant disease seem warranted but our results are not encouraging.
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