Abstract
Purpose: :
To investigate the efficacy of four different therapies based on VEGF Inhibition in neovascular age related macular degeneration (AMD).Patients and
Methods: :
Between January 2006 and October 2007 a total of 141 patients were included in this retrospective, controlled study with a follow up of 12 months. Four different therapeutic regimen were used: the first group was treated with Macugen (Pegaptanib) (n=11), the second group received Lucentis (Ranibizumab) (n=36), the third group was treated with Avastin (Bevacizumab) (n=42) and the fourth group was injected with Avastin after an initial injection with Lucentis (n=52). The intravitreal injections were performed in the sterile operating room and topical antibiotics were administered pre -and postoperatively.
Results: :
The mean baseline Snellen visual acuity was 0.2 ± 0.15 (0.01-0.7). Sixty-three percent of our study population was female and the mean age was 76 ± 9. The indication for reinjection was chosen on a as needed base depending from visual acuity, funduscopy and OCT. Thus a mean of 4.1 injections were performed in the Lucentis/Avastin group, 1.4 in the Lucentis group, 3.1 in the Macugen group and 2.9 in the Avastin group. Maintenance of visual acuity after 12 months was observed in 91% in the Avastin group, 72% in the Lucentis group, 77% in the Lucentis/Avastin group and 86% in the Macugen group. An increase in visual acuity of ≥ 3 lines was seen in 36% of the Avastin patients, in 22% of the Lucentis patient, in 27% of the Lucentis/Avastin patients and in 14% of the Macugen treated eyes. A decrease of ≥3 lines after 12 months observation occurred in 28% of the Lucentis group, in 9% of the Avastin group, 14% of the Macugen group and in 23% of the Lucentis/Avastin group. In respect to side effects local side effects like floaters were observed occasionally. No endophthalmitis occurred in our patients. In one case a stroke occurred and severe cardial arrhythmia was observed in another patient in the Lucentis/Avastin group.
Conclusions: :
Overall the efficacy in respect to maintenance of the visual acuity could be shown for all groups. Interestingly, our patients did not achieve the results in regard to increase in visual acuity with Lucentis as was shown in the ANCHOR and MARINA studies. In contrast Macugen patients were above the results published so far in the VISION study. The results in the Lucentis/Avastin group were favorable both in respect to maintenance and increase of visual acuity. A comparison with recent medical literature was not possible for this group.
Clinical Trial: :
EUDRACT 2006-002841-34
Keywords: age-related macular degeneration • clinical (human) or epidemiologic studies: outcomes/complications • vascular endothelial growth factor