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Shinichi Sakamoto, Hidenori Takahashi, Yuji Inoue, Yasuo Yanagi, Aya Sato, Mikiko Takezawa, Tatsuro Tanabe, Yujiro Fujino, Hidetoshi Kawashima; Effects of central macular thickness on visual and anatomical outcomes in age-related macular degeneration patients: comparison between ranibizumab and aflibercept.. Invest. Ophthalmol. Vis. Sci. 2016;57(12):3688.
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© ARVO (1962-2015); The Authors (2016-present)
We have reported that during the course of treatment with ranibizumab, thinner central macular thicknesses (CMT) was, unexpectedly, associated with worse the best-corrected visual acuity (BCVA) in neovascular age-related macular degeneration (nAMD) when the CMT was less than 300 µm. Given that aflibercept is more potent to suppress exudative change than ranibizumab, short term prognosis may be different between those with thick CMT and those without. In this study, the effect of the last injections of ranibizumab were compared to that of the first injections of aflibercept in nAMD.
Consecutive 48 eyes of 48 patients with nAMD switched from ranibizumab to aflibercept at the Jichi Medical University Hospital and JCHO Tokyo Shinjuku Medical Center were followed-up at least one month after injections of the first aflibercept as of April 1, 2014. The distance from internal limiting membrane to the Bruch’s membrane was measured as CMT in optical coherence tomography.Analysis of variance was used to determine whether there were any significant correlations between CMT at the first aflibercept and 1 month prognosis difference between the last ranibizumab and the first aflibercept in CMT and BCVA (logarithm of the minimum angle of resolution units) (Figure 1).Paired Student’s t-test was used to compare prognosis between ranibizumab and aflibercept in less than 300 μm CMT group and over 300 μm CMT group respectively.
Thicker CMT was associated with superiority of aflibercept in BCVA (p = 0.044) and CMT (p = 0.0004). There was no significance between CMT at the last ranibizumab and that of the first aflibercept (mean: 340 vs 360 μm, p = 0.27). It's about 300 μm of CMT to change from superior of ranibizumab to superior of aflibercept (Figure 2).Gain of visual acuity after the intravitreal injections of ranibizumab was larger than that of aflibercept in nAMD with less than 300 µm of CMT (mean: -0.12 vs -0.052, p = 0.023). That with more than 300 µm of CMT had no significance (-0.061 vs -0.083, p = 0.61). CMT suppression after the intravitreal injections of aflibercept was larger than that ranibizumab in nAMD with more than 300 µm of CMT (-39 vs -130, p = 0.012). That with less than 300 µm of CMT had no significance (-21 vs -4.7, p = 0.40).
CMT may be useful to choose drug in nAMD.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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