Comparison of Efficacy of Bevacizumab and Ranibizumab in the Treatment of Occult Choroidal Neovascular Membrane in Age Related Macular Degeneration

Abstract

Purpose: : To compare the short term anatomical and visual outcomes of Bevacizumab and Ranibizumab for the treatment of occult choroidal neovascular membrane (CNVM) associated with age related macular degeneration (AMD)

Methods: : A retrospective review was performed on 30 consecutive patients treated with either intravitreal Bevacizumab or Ranibizumab for occult CNVM associated with AMD. Patients that were funded for Ranibizumab (n=15 ) were treated with it, while the others (n=15) were treated with Bevacizumab. The patients were followed up for a period of 24 weeks. At each visit best corrected ETDRS visual acuity was performed followed by ophthalmic examination and optical coherence tomography (OCT). Successful outcome was defined as (1) stabilisation of vision (loss of less than 15 letters (ETDRS) (2) or gain of more than 10 letters and (3) significant reduction in Central Macular Thickness(CMT) at the end of treatment (p<0.05).

Results: : The mean number of injections in the Ranibizumab group was 4.5 and in the Bevacizumab group was 3.3. No serious drug related ocular or systemic side effects were noted. Improvement in visual acuity (VA) and reduction in mean CMT were evident in both cases. Ranibizumab resulted in mean improvement in visual acuity of 5.41 letters (p<0.01) and mean reduction in CMT of 56.3 microns (p<0.001). Bevacizumab resulted in mean improvement of visual acuity 4.93 letters (p <0.01) and mean reduction in CMT of 50.4 microns (p<0.001). When comparing the two groups there was no significant difference in outcome of both VA (p=0.7904) and CMT (p=0.0710). In the Ranibizumab group 85% had stabilisation of vision and 25% had gain of more than 10 letters while the Bevacizumab group had 82% stabilisation of vision and gain of more than 10 letters in 19% of patients . There was a significant reduction in CMT in both the groups at the end of treatment.(p<0.05)

Conclusions: : On comparison there was no statistical significance in outcomes in between the two treatment groups (Ranibizumab and Bevacizumab). This needs to be confirmed in larger and long term prospective randomised trials.

Keywords: choroid: neovascularization • macula/fovea • age-related macular degeneration