Abstract
Purpose: :
There are two approved and effective ways of treating exsudative age-related macular degeneration: Pegaptanib (Macugen®) and Ranibizumab (Lucentis®). Unspecific inhibition of all VEGF-types by Ranibizumab is discussed to be more dangerous because of suspected higher rates of severe cardiovascular accidents but is more effective than selective inhibition by Pegaptanib, which is less effective but discussed to be safer. The current study tried to find out wether a combination therapy might combine both advantages.
Methods: :
Between February 2008 and October 2009 Patients with exsudative age-related macular degeneration were during upload either treated with three times Ranibizumab (group II) when there was no history of cardiovascular accident or with a combination therapy (first injection Ranibizumab, then twice Pegaptanib) when there was positive history (group I). Best-corrected visual acuity (BCVA) was obtained and compared between the two groups until one month after upload.
Results: :
In group I 42 eyes, in group II 958 eyes were treated and retrospectively evaluated. Results and BCVA match the expectancies of MARINA-, ANCHOR- and PrONTO-study, but only up to the second injection, at which the groups‘ treatment differs. Group II patients continue to improve, but group I patients lose visual acuity continously until the first visit 4 weeks after the third injection, at which the difference between the groups becomes statistically significant. (group I loses 0.35 Snellen lines, group II gains 1.20 lines; p = 0,007). This is not due to the positive cardiovascular history as earlier treated "risk patients" who had obtained Ranibizumab only gain 1.17 Snellen lines as well.
Conclusions: :
Treatment of patients with a history of cardiovascular accidents with Ranibizumab and Pegaptanib seems to be less effective than treatment with Ranibizumab alone. The presumed lower risk for cardiovascular accidents when treating patients this way results in worse visual acuity during upload and has to be discussed individually with each patient.
Keywords: age-related macular degeneration • injection