Abstract
Purpose: :
Intravitreal bevacizumab (IVB) and ranibizumab (IVR) have been used for treatment of neovascular AMD with excellent results. This study is to report our experience with these two anti-VEGF agents, and to compare potential systemic and ocular complications.
Methods: :
Retrospective chart review of neovascular AMD patients treated with IVB 1.25 mg) or IVR (0.5 mg) (Genentech Inc, South San Francisco) between December 2005 to September 2007. With a total of 75 eyes from 66 patients, 50 eyes of 42 patients received IVB, and 25 eyes of 24 patients IVR. Mean ages were 78.4 and 76.4 years for IVB and IVR, respectively. Repeat IVB or IVR was performed when visual acuity was worse, or leakage noted on optical coherence tomography (OCT) and/or fluorescein angiograph (FA). Patients were followed with Snellen visual acuity (VA), eye exam, OCT and/or FA. Potential intraocular complications were closely monitored. Patients were also asked about their blood pressure measurements and any signs suggesting GI bleeding, heart attack, stroke, etc.
Results: :
Mean follow-up time for patients with IVB was 10.8 months (range 1-20), with an average of 3.14 injections for each patient (range 1-7) during this period. Mean follow-up was 6.9 months for IVR (range 1-14), with an average of 3.28 injections for each patient (range 1-7).In IVB group, mean acuity was 20/279 before and 20/220 after treatment; whereas in IVR group, 20/269 before and 20/259 after. Although no significant difference of acuity was noticed before and after treatment, it tended to improve with either treatment. There was no statistical difference in change of acuity between IVB and IVR groups.However, significant improvement in central foveal thickness was observed on OCT in both groups. Foveal thickness on average decreased 69 µm in IVB (p<0.002), and 78 µm in IVR groups (p <0.006). There was no statistical difference in the decrease between two groups.No intraocular complications, such as endophthalmitis, retinal detachment, vitreous hemorrhage, or traumatic cataract were noted. No systemic complications, such as significant blood pressure elevation, or others as described in the Methods were reported by patients.
Conclusions: :
IVB and IVR stabilized visual acuity and decreased foveal thickness on OCT in patients with neovascular AMD. No intraocular or systemic complications were noticed or reported due to either treatment. Our study suggests that intravitreal bevacizumab is as safe as ranibizumab for treatment of neovascular AMD. A large clinical trial is needed to confirm these findings.
Keywords: age-related macular degeneration • retina • clinical (human) or epidemiologic studies: treatment/prevention assessment/controlled clinical trials