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

Abstract

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.]]>

Results of Intravitreal Ranibizumab With a PRN Regimen in the Treatment of Extrafoveal and Juxtafoveal Neovascular Membranes in Age-Related Macular Degeneration

“…According to this study, bevacizumab and ranibizumab seemed to be the treatment of choice for patients with AMD and nonsubfoveal CNV. 30 Arias et al evaluated the efficacy and safety of intravitreal ranibizumab on a PRN basis in 15 patients with juxtafoveal and extrafoveal naive CNV because of AMD. Controls were made monthly with a complete ophthalmologic examination and an OCT, whereas a fluorescein angiography was performed at the investigator's discretion.…”

“…29 The efficacy of intravitreal ranibizumab and bevacizumab in the treatment of nonsubfoveal CNV was investigated only in three small case series with a short follow-up. [30][31][32] An unequivocal anti-vascular endothelial growth factor drugs regimen has not been proven for the treatment of retinal angiomatous proliferation (RAP) because of the paucity of long-term data and the lack of clinical trials, 33,34 ranibizumab and bevacizumab, either alone or combined with photodynamic therapy, achieved good results in terms of functional and anatomical features. [35][36][37][38][39][40][41][42] Nevertheless till now, differences in results because of a different location have not been taken into consideration.…”

Tratamento da degeneração macular relacionada à idade com neovascularização de coróide extrafoveal: análise de uma série de casos e revisão de literatura

“…Os achados deste estudo respaldam o uso do antiangiogênico na degeneração macular relacionada à idade com neovascularização de coróide extrafoveal clás- sica e oculta, e são similares aos dos estudos multicêntricos (11,12) para degeneração macular relacionada à idade com neovascularização de coróide subfoveal, e também para o tratamento da neovascularização de coróide extrafoveal, como também sugerem outros autores (20)(21)(22) . A prevalência da neovascularização de coroide não subfoveal foi avaliada em vários estudos.…”

“…Apesar de outras possibilidades terapêuticas já terem sido avaliadas, como a fotocoagulação com laser e a terapia fotodinâmica (PDT), recentes trabalhos e este mostraram que os resultados funcionais são extremamente favoráveis à indicação de antiangiogênico (20,21) (no caso deste estudo o Ranibizumab) comparado à fotocoagulação com laser térmico e ao PDT.…”

“…Na forma extrafoveal tem sido utilizada a fotocoagulação a laser térmico, com recidiva e dano ao campo visual (15) e a terapia fotodinâmica (PDT) com resultados imprecisos (19) . Relatos recentes referem o uso de Ranibizumab e Bevacizumab com bons resultados na forma extrafoveal (20,22) . Desta forma, este trabalho visa avaliar a resposta à injeção intravítrea de Ranibizumab, 0,5mg, em monoterapia, em pacientes portadores de DMRI na sua forma exsudativa com neovascularização de coróide de localização não subfoveal, podendo ser extrafoveal ou justafoveal e fazer uma revisão da literatura.…”