Intravitreal ranibizumab and bevacizumab for the treatment of nonsubfoveal choroidal neovascularization in age-related macular degeneration

Intravitreal ranibizumab and bevacizumab for the treatment of nonsubfoveal choroidal neovascularization in age-related macular degeneration

Alternative title Ranibizumab e bevacizumab intravítreo no tratamento da neovascularização de coróide extrafoveal da degeneração macular relacionada à idade
Author Roller, Aaron Brock Google Scholar
Amaro, Miguel Hage Autor UNIFESP Google Scholar
Institution University of Iowa Department of Ophthalmology Hospitals and Clinics
Universidade Federal de São Paulo (UNIFESP)
Abstract PURPOSE: To investigate the efficacy of vascular endothelial growth factor-specific (VEGF) monoclonal antibodies in the treatment of choroidal neovascularization secondary to age-related macular degeneration (AMD) that does not extend beneath the foveal center (nonsubfoveal CNV). METHODS: The study design was a retrospective chart review of consecutive patients over a two-month period under active treatment with bevacizumab and/or ranibizumab for neovascular AMD. Patients with neovascularization within the macula that did not extend beneath the center of the foveal avascular zone, along with at least one large drusen (>125 µ) or many intermediate size (63-124 µ) drusen were included. Best corrected Snellen visual acuity and optical coherence tomography (OCT) analysis of the central macular thickness was recorded for each visit. Serial injections of bevacizumab and/or ranibizumab were administered until there was resolution of subretinal fluid clinically or by OCT. Data over the entire follow-up period were analyzed for overall visual acuity and OCT changes. All patients had follow-up since diagnosis of at least 6 months (mean=9.6 months). RESULTS: Of the thirteen included patients, eleven had reduction of retinal thickening in the area involved by the CNV. The remaining two patients did not have OCT data available but had no fluid or activity on clinical examination at last follow-up. One patient (8%) lost one line of vision; one (8%) remained stable, and eleven (84%) gained one or more lines of visual acuity. Three patients (23%) gained three or more lines. The average treatment outcome for all patients was a gain of 1.7 ± 1.3 lines of Snellen acuity. Both therapeutic agents were effective, with an average gain of 1.6 ± 0.6 lines for patients treated with bevacizumab, 1.5 ± 1.9 lines gained for patients treated with ranibizumab and 2.5 ± 0.7 lines gained in the two patients who received both agents over the course of their treatment. CONCLUSIONS: The use of intravitreal anti-VEGF agents for nonsubfoveal CNV in AMD is effective. Our results are comparable to published results from large-scale trials of anti-VEGF therapy for subfoveal CNV. Our data support the idea that bevacizumab or ranibizumab appear to be the treatment of choice for AMD patients with nonsubfoveal CNV.

OBJETIVO: Investigar a eficácia dos anti-angiogênicos ranibizumab e bevacizumab injetados intravítreo, no tratamento de pacientes com neovascularização de coróide extrafoveal em degeneração macular relacionada à idade. MÉTODOS: Foram avaliados 13 pacientes com neovascularização de coróide extrafoveal em degeneração macular relacionada à idade do Setor de Retina e Vítreo do Departamento de Oftalmologia da Universidade de Iowa, Estados Unidos, que foram tratados por meio de injeção vítrea de ranibizumab e bevacizumab separadamente, em um período de dois anos. Após as injeções iniciais os pacientes foram acompanhados por exames de OCT e as injeções foram repetidas com 4 a 8 semanas dependendo da presença de líquido sub-retiniano e macular. RESULTADOS: Doze pacientes tiveram ganhos de linhas de visão se comparados com a visão antes do tratamento. Onze pacientes tiveram redução do espessamento retiniano na área envolvida pelo CNV e diminuição e resolução do espessamento macular na sua visita final de avaliação. Um paciente (8%) perdeu uma linha de visão se comparado à visão prévia ao tratamento. Pacientes tratados com o ranibizumab tiveram em média 2,5 ± 0,7 ganhos de linhas de visão. Pacientes tratados com bevacizumab tiveram em média 1,6 ± ganhos de linhas de visão. CONCLUSÃO: No tratamento de pacientes com a neovascularização de coróide extrafoveal em degeneração macular relacionada à idade, a injeção vítrea de ranibizumab ou bevacizumab é efetiva e pode ser a opção de escolha.
Keywords Choroidal neovascularization
Macular degeneration
Antibodies, monoclonal
Angiogenesis inhibitors
Visual acuity
Neovascularização coroidal
Degeneração macular
Anticorpos monoclonais
Inibidores da angiogênese
Acuidade visual
Language English
Date 2009-10-01
Published in Arquivos Brasileiros de Oftalmologia. Conselho Brasileiro de Oftalmologia, v. 72, n. 5, p. 677-681, 2009.
ISSN 0004-2749 (Sherpa/Romeo)
Publisher Conselho Brasileiro de Oftalmologia
Extent 677-681
Access rights Open access Open Access
Type Article
SciELO ID S0004-27492009000500016 (statistics in SciELO)

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