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V. D. Alfaro, J. B. Kerrison, E. P. Jablon, M. Rodriguez-Fontal, R. Garcia, F. Gomez-Ulla; Switching to Ranibizumab Treatment From Intravitreal Bevacizumab Treatment in Patients With Neovascular Age-Related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2007;48(13):3346.
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Ranibizumab (LucentisTM) is a humanized antigen-binding antibody fragment (Fab) that neutralizes all biologically active forms of vascular endothelial growth factor-A and its degradation products. Ranibizumab was recently approved by the FDA for the treatment of neovascular age-related macular degeneration (AMD). This retrospective case series reports on patients with neovascular AMD who responded poorly to off-label monthly intravitreal (ITV) injections of bevacizumab and who subsequently were switched to and successfully treated with monthly ITV injections of ranibizumab.
Nine patients were evaluated who previously received and responded poorly to ITV bevacizumab (2.4 mg; 1-5 injections) and subsequently received 3 monthly ITV injections of ranibizumab (0.5 mg). Patients with subfoveal choroidal neovascularization (CNV) were offered ranibizumab treatment if they continued to experience visual loss or if the anatomic appearance on fluorescein angiography or optical coherence tomography (OCT) worsened despite treatment with ITV bevacizumab. Best-corrected ETDRS visual acuity (BCVA) and central retinal thickness (measured with OCT) were evaluated at baseline; then at 2 weeks; and at 1, 2, and 3 months.
After 1 month of follow-up, ranibizumab resulted in stable vision (a loss of <15 letters) in 100% of patients, the median BCVA had improved from 20/80 to 20/50 and there was a mean decrease in central retinal thickness of 78.1 µm compared with baseline. Thus far, no serious ocular or systemic adverse events have been reported in these patients.
Ranibizumab may stabilize or improve vision as well as decrease central retinal thickness in patients with neovascular AMD who previously responded poorly to off-label ITV bevacizumab treatment.
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