Effect of Ranibizumab in Eyes With Exudative Age-Related Macular Degeneration Previously Treated With Pegaptanib: A Retrospective Consecutive Case Series

Abstract

Purpose:: Vascular endothelial growth factor A (VEGF-A) has been implicated in the development of exudative age-related macular degeneration (AMD). Ranibizumab (Lucentis^TM) is a humanized antigen-binding antibody fragment (Fab) that inhibits all VEGF-A isoforms and their biologically active degradation products, whereas pegaptanib (Macugen^®) is designed to target only VEGF₁₆₅ and may bind the longer VEGF-A isoforms. Ranibizumab was recently approved by the FDA for the treatment of exudative AMD. This retrospective consecutive case series reports on patients with exudative AMD who previously received pegaptanib and were switched to ranibizumab.

Methods:: Twenty-eight eyes from 25 patients who previously received intravitreal (ITV) pegaptanib (injections: mean, 8; range, 4-12) were evaluated and subsequently received monthly ITV ranibizumab (0.5 mg; injections: mean, 3; range, 2-6). Patients had active predominantly classic, minimally classic, or occult membranes; treatment with other modalities before pegaptanib initiation was permissible. Best-corrected Snellen visual acuity (VA) and central retinal thickness (measured with optical coherence tomography) were evaluated before and after each treatment. Ocular and systemic adverse events were also recorded.

Results:: Ninety-two percent of patients lost fewer than 2 lines of VA after treatment with ranibizumab. Four eyes (30.8%) with better vision at enrollment (20/100 or better; n=13) gained ≥1 line of VA following pegaptanib treatment. Additionally, six patients (42.9%) with better vision at the time of switch to ranibizumab (n=14) gained ≥1 line of VA following ranibizumab treatment. There was a mean decrease in central retinal thickness of 20.7 ± 44.2 µm after ranibizumab treatment. No serious ocular or systemic adverse events have been reported in these patients so far.

Conclusions:: Switching from ITV pegaptanib to ranibizumab treatment seems to be well tolerated and may stabilize vision as well as decrease central retinal thickness in patients with exudative AMD.

Keywords: age-related macular degeneration • choroid: neovascularization