Intravitreal Ranibizumab versus Thermal Laser Photocoagulation in the Treatment of Extrafoveal Classic Choroidal Neovascularization Secondary to Age-Related Macular Degeneration

Abstract

Background: To compare the efficacy of thermal laser photocoagulation versus intravitreal ranibizumab for the treatment of extrafoveal classic choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD). Methods: We conducted a retrospective study on 24 eyes with extrafoveal classic CNV secondary to AMD, treated either with thermal laser photocoagulation (group 1) or with intravitreal ranibizumab (group 2). Visual acuity, number of injections/sessions and recurrence rate were assessed. Results: The mean follow-up time was 23.6 ± 2.26 and 19.1 ± 9.74 months for group 1 and 2, respectively. Mean best corrected visual acuity (BCVA) of groups 1 and 2 was 0.59 ± 0.32 and 0.46 ± 0.30 logMAR, respectively (p = 0.343). At the end of the follow-up, mean BCVA of group 1 was 0.92 ± 0.35 and of group 2 0.16 ± 0.12 logMAR and differed statistically compared to baseline (p = 0.02 and p = 0.006, respectively). There was a statistically significant difference between the two groups as far as BCVA at the end of the follow-up was concerned (p < 0.0001). The patients in group 1 received on average 1.38 sessions of thermal laser photocoagulation, while patients in group 2 received on average 4 injections of ranibizumab. The recurrence rate in the laser group was 84.6%, while in the ranibizumab group it was 18.2% (p < 0.001). Specifically, the mean time of recurrence in the laser group was 11.5 months, whereas in the ranibizumab group it was 18 months (p = 0.048). Conclusion: Intravitreal ranibizumab showed promising results in BCVA improvement and decrease in macular thickness in patients with extrafoveal classic CNV due to AMD, with a small number of injections. Laser photocoagulation treatment presented worsening in BCVA and high recurrence rate in our study with long-term follow-up.

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

“…Authors described the maintenance of a good BCVA during the whole follow-up. 32 In our study, we found 80.6% of recurrences at 1-year follow-up and 100% at 2-year follow-up.…”

“…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.…”

Intravitreal Anti-vascular Endothelial Growth Factor for Newly Diagnosed Symptomatic Polypoidal Choroidal Vasculopathy with Extrafoveal Polyps

“…Intravitreal injection of anti-vascular endothelial growth factor (VEGF) is an effective treatment for exudative age-related macular degeneration (AMD) [ 1 2 3 4 ]. Recent reports have demonstrated that anti-VEGF therapy is also effective in treating extrafoveal exudative AMD [ 5 6 ], and one study demonstrated that the treatment outcome of anti-VEGF therapy was superior to that of laser photocoagulation in extrafoveal lesions [ 6 ].…”

Wann wird heute noch gelasert?

“…Wachstumsfaktor "vascular endothelial growth factor" (VEGF) multimodaler geworden, sodass die Laserbehandlung bei einigen wichtigen Erkrankungsbildern, wie z. B. bei choroidalen Neovaskularisationen der Makula, ihren Stellenwert verloren hat [7,8].…”