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P. J. Stewart, R. Singh, H. Kim, E. R. Holz, P. E. Carvounis; Treatment of Large Retinal Pigment Epithelium Detachment Associated With Age-Related Macular Degeneration With Bevacizumab or Ranibizumab. Invest. Ophthalmol. Vis. Sci. 2008;49(13):5567.
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Intravitreous bevacizumab (AVA) and ranibizumab (LUC) are efficacious in the treatment of exudative age-related macular degeneration (ARMD). Our clinical impression is that large pigment epithelium detachments (PED) in exudative ARMD may respond better to intravitreous bevacizumab. We compared the visual outcomes of intravitreous bevacizumab to intravitreous ranibizumab for the treatment of large PEDs associated with ARMD.
Retrospective comparative study of 17 eyes of 17 consecutive, previously untreated patients with ARMD-associated PEDs measuring more than 1000µm in maximal diameter and 300µm in maximal height, initial visual acuity better than 20/200, treated with one or more sessions of AVA (9 eyes of 9 patients) or LUC (8 eyes of 8 patients).
Baseline logMAR visual acuity was 0.44 in the AVA group (20/55), 0.38 in the LUC group (20/48, p=0.64). At 3 months, logMAR visual acuity improved to 0.33 (20/42) in the AVA group (p=0.06) but did not improve in the LUC group (logMAR 0.37 [20/46], p=0.9). Final visual acuity was 0.34 (20/44) in the AVA group (mean follow-up 7.7 months) was better than 0.63 (20/86) found in the LUC group (mean follow-up 8.25 months) a difference that did not reach statistical significance (p=0.09).
We could not confirm our clinical impression of improved visual outcomes in the treatment of large ARMD-associated PEDs with intravitreous bevacizumab. This could be a result of the small number of patients. Using our study data 20 patients in each group would be required to detect an excess improvement of 2 lines in the intravitreous bevacizumab group with a power of 0.80 at alpha 0.05.
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