ABSTRACT
BACKGROUND AND OBJECTIVE: To evaluate the effect of intravitreal ranibizumab in patients with leaking disciform scars. PATIENTS AND METHODS: In this retrospective case series, 31 eyes received one or two ranibizumab injections for treatment of choroidal neovascularization. Visual acuity, central retinal thickness, and macular volume were measured prior to injection and at 1-month follow-up. RESULTS: After one injection (n = 31), mean optical coherence tomography (OCT) central foveal thickness decreased from 317 to 242 microm (P = .00016). Mean OCT macular volume decreased from 7.89 to 6.80 mm3 (P = .00019). After two injections (n = 12), mean OCT central foveal thickness decreased from 310 to 248 microm following the second injection (P = .04). Mean OCT macular volume decreased from 7.80 to 6.43 mm3 at 1-month follow-up after a second injection (P = .006). There was no significant change in visual acuity after injections. CONCLUSION: In the short-term, ranibizumab decreases the leakage associated with choroidal neovascularization in chronic macular degeneration.
Subject(s)
Angiogenesis Inhibitors/therapeutic use , Antibodies, Monoclonal/therapeutic use , Choroidal Neovascularization/drug therapy , Macular Degeneration/drug therapy , Aged , Aged, 80 and over , Antibodies, Monoclonal, Humanized , Choroidal Neovascularization/diagnosis , Exudates and Transudates , Female , Follow-Up Studies , Humans , Injections , Macular Degeneration/diagnosis , Male , Middle Aged , Ranibizumab , Retrospective Studies , Tomography, Optical Coherence , Treatment Outcome , Vascular Endothelial Growth Factor A/antagonists & inhibitors , Visual Acuity , Vitreous BodyABSTRACT
BACKGROUND: Neovascular age-related macular degeneration is characterized by choroidal neovascularization that has a complex pathogenesis. Combining agents that have different mechanisms of action (i.e., verteporfin photodynamic therapy, antivascular endothelial growth factor, and/or anti-inflammatory therapies) could maximize clinical benefits through potential complementary effects. This review discusses findings from studies investigating this hypothesis. METHODS: Articles were retrieved from PubMed using relevant search terms. Abstracts from recent scientific meetings and details of ongoing trials from clinicaltrials.gov were also included. RESULTS: Following its approval, verteporfin was important in the management of choroidal neovascularization due to age-related macular degeneration for several years. Improved visual outcomes have now been reported with antiangiogenic agents (e.g., intravitreal ranibizumab), especially when frequently administered. Results from investigator-sponsored trials, retrospective case studies and Registries, which have provided insights into the latest findings from clinical practice in the "real-world" setting, as well as randomized controlled trials, suggest that a combination approach is generally well tolerated and may maintain improvements in visual and anatomic outcomes with fewer retreatments. CONCLUSION: A rationale exists for investigating combination approaches to target different processes in choroidal neovascularization pathogenesis, which may optimize treatment benefits in neovascular age-related macular degeneration. Encouraging data suggest that combination strategies are not associated with major adverse events.
Subject(s)
Angiogenesis Inhibitors/therapeutic use , Choroidal Neovascularization/drug therapy , Macular Degeneration/drug therapy , Photochemotherapy , Photosensitizing Agents/therapeutic use , Porphyrins/therapeutic use , Antibodies, Monoclonal/therapeutic use , Antibodies, Monoclonal, Humanized , Aptamers, Nucleotide/therapeutic use , Bevacizumab , Drug Therapy, Combination , Humans , Ranibizumab , Vascular Endothelial Growth Factor A/antagonists & inhibitors , VerteporfinABSTRACT
BACKGROUND AND OBJECTIVE: Vascular endothelial growth factor (VEGF)-A, both necessary and sufficient in promoting ocular neovascularization, is an attractive therapeutic target. Combining nonselective and selective VEGF blockade may provide clinical benefit with minimal risks in the treatment of neovascular age-related macular degeneration (AMD). PATIENTS AND METHODS: Twenty patients with all subtypes of neovascular AMD and a broad range of baseline vision were treated with intravitreal bevacizumab followed by pegaptanib sodium for 54 weeks. Visual acuity measurements, biomicroscopy, funduscopy, fluorescein angiography, optical coherence tomography, and adverse event assessments were performed. RESULTS: Mean visual acuity improved from approximately 20/200 at baseline to 20/80. All patients experienced an improvement in retinal thickness, ranging from -47 to -297 microns. Adverse events were limited to transient irritation or redness. No significant elevation in intraocular pressure occurred following either bevacizumab or pegaptanib injections. CONCLUSIONS: Nonselective VEGF blockade with bevacizumab induction and selective VEGF165 blockade with pegaptanib as maintenance therapies may offer clinically meaningful outcomes with acceptable safety profiles in patients with AMD.
