title: Intravitreal ranibizumab and bevacizumab for the treatment of nonsubfoveal choroidal neovascularization in age-related macular degeneration.
abstract: OBJECTIVE
  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 micro) or many intermediate size (63-124 micro) 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.
authors.affiliation: Hospitals and Clinics, Department of Ophthalmology, University of Iowa, Iowa City, IA, USA. aaron-roller@uiowa.edu
authors.forename: Aaron Brock
authors.initials: AB
authors.lastname: Roller
authors.forename: Miguel Hage
authors.initials: MH
authors.lastname: Amaro
mesh_terms: D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D000068258:Bevacizumab; D020256:Choroidal Neovascularization / Q000188:drug therapy*; D005260:Female; D005500:Follow-Up Studies; D005584:Fovea Centralis / Q000187:drug effects* / Q000473:pathology; D006801:Humans; D008268:Macular Degeneration / Q000188:drug therapy*; D008297:Male; D000069579:Ranibizumab; D012189:Retrospective Studies; D016896:Treatment Outcome; D014792:Visual Acuity / Q000187:drug effects / Q000502:physiology
chemical_list: D020533:Angiogenesis Inhibitors; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000068258:Bevacizumab; D000069579:Ranibizumab