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Z. B. Ravage, R. M. Singa, K. H. Packo, K. A. Rezaei; Visual Outcome in Eyes Switched From Pegaptanib Sodium to Ranibizumab for Neovascular Age-Related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2007;48(13):4531.
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To evaluate the efficacy of ranibizumab (pan anti-VEGF) treatment in patients with neovascular age-related macular degeneration (AMD) that had been previously treated with pegaptanib sodium (selective anti-VEGF).
We conducted a retrospective chart review of 68 patients who underwent anti-VEGF treatment for neovascular AMD with pegaptanib sodium and ranibizumab. Patients were treated by 4 retina physicians in 2 offices of Illinois Retina Associates from March of 2005 to November 2006. 35 patients were excluded from the study due to other treatments (laser, photodynamic therapy, bevucizamab) or non-AMD-related choroidal neovascularization (CNV). 33 eyes of 33 patients were included in the study. 20 patients were female and 13 were male. The mean patient age was 81 years (range 68-92). All eyes received intravitreal injections of 0.3 mg of pegaptanib sodium (mean 4.0 injections, range 1-13) every 6 weeks. Patients were switched to monthly injections of 0.5 mg ranibizumab (mean 3.65 injections, range 1-7) once it became available. The primary efficacy endpoint was lines of vision gained. Best corrected visual acuity was recorded with the Snellen chart on all visits. Snellen acuities were converted to logMAR scale and lines gained or lost were calculated.
There were no cases of endophthalmitis in 426 injections. After switching treatment from pegaptanib sodium to ranibizumab, 7 eyes (21%) gained 3 or more lines, 23 eyes (70%) maintained or gained vision, 6 eyes (18%) lost less than 3 lines and 4 eyes (12%) lost 3 or more lines of vision. 9 of 16 eyes (56%) that lost vision on pegaptanib sodium maintained or gained vision after switching to ranibizumab. All 6 patients that maintained vision with pegaptanib sodium therapy maintained or gained vision on ranibizumab. 7 of 10 eyes (70%) that lost vision after switching to ranibizumab had previously lost vision on pegaptanib sodium.
Use of pegaptanib sodium for the treatment of neovascular AMD does not appear to reduce the efficacy of subsequent treatment with ranibizumab. Patients switched from treatment with a selective anti-VEGF medication to a pan anti-VEGF medication show a tendency for further stabilization or improvement in their visual acuity.
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