Author: Havva Kaldırım (Turkey)
Co-authors: Fatma Savur
To compare the efficacy and treatment switch responce of two intravitreal anti-vascular endothelial growth factor (anti-VEGF) agents, ranibizumab and aflibercept, for the treatment of large serous pigment epithelium detachment (sPED) due to age-related macular degeneration (AMD) .
We included 38 AMD patients (38 eyes) having sPED ≥200 μm in fovea that is measured manually with optic coherence tomography (OCT). All patients were treatment naïve before anti-VEGF therapy. Patients received a serial of three monthly Ranibizumab (0.5 mg/0.05 ml) or Aflibercept (2.0 mg/0.05 ml) followed by pro re nata (PRN) schedule. The treatment protocol after switched consisted of a fixed dosing regimen comprising of monthly injections for first 3 months, followed by PRN injections in last visit of treatment.
In this retrospective study, cases were divided into 2 groups. Group 1 (22 eyes) treated initially with intravitreal Ranibizumab (0.5 mg/0.05 ml) and later switched to Aflibercept (2.0 mg/0.05 ml). Group 2 (16 eyes) started treatment with intravitreal Aflibercept (2.0 mg/0.05 ml) and later switched to Ranibizumab (0.5 mg/0.05 ml). The outcome measures of this study were best corrected visual acuity (BCVA), PED height, PED width, the presence of subretinal fluid (SRF), intraretinal fluid (IRF), number of injections and and follow up time. Examination findings were recorded at baseline, month 3, month 6 and at time point of switch, 3 month , 6 months and at last follow up visit post-switch. Student’s t test and repeated measurements ANOVA were calculated to analyze variables at baseline, at switch and change in variables at last visit.
There was not a significant difference in BCVA, PED height, PED width between the two groups at pre-switch, at-switch and after-switch visits(p<0.05).All patients had SRF and IRF at baseline two groups.At switch point, 22(%100) eyes in Group 1 ,16(%100) eyes in Group 2 had SRF.In Group 1, 11(%50) eyes showed SRF and 8(%50) eyes in Group 2 had SRF at last visit after switching which was insignificant (p=1.00).Thirteen eyes(%59) eyes in Group 1 and 5(%31) eyes in Group 2 had IRF at baseline. At switch point, 1(%4.5) eye in Group 1 and 1(%6) eye in Group 2 had IRF.One(%4.5) eye in Group 1 and 1 eye(%6) in Group 2 had IRF at last visit after switching(p=0.816).sPED complete resolved in 8 eyes(%36) in Group 1 and 5(%31) eyes in Group 2, whose sPED height was less than 350 microns.The mean number of injections of both groups at the time of the switch and at the last visit after the switch were found to be similar(p=0,995,p=0,384,respectively).The follow-up periods of both groups at the time of the switch and at the last visit after the switch were found to be similar(p=0,404,p=0,884,respectively).In Group1, retinal pigment epitelial collapse was observed in one case before switch.
There is no clear consensus on which anti-VEGF and which treatment regimen should be used in patients with sPED due to AMD. We aimed to treatment once visual acuity and sPED have stabilized and SRF or IRF have resolved. Our study found that both anti-VEGF treatment showed similar anatomical effectiveness with significant reduction in PED height and resolution rate of SRF, IRF. The other finding in our study was complete resolved sPED in eyes with below 350 microns sPED height.
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