Alternating Bi-Weekly Intravitreal Ranibizumab and Bevacizumab for Refractory Neovascular Age-Related Macular Degeneration with Pigment Epithelial Detachment.
OBJECTIVE
To describe visual and anatomical outcomes following bi-weekly intravitreal ranibizumab/bevacizumab injections in eyes with refractory neovascular age-related macular degeneration (AMD) and pigment epithelial detachment (PED).


METHODS
Retrospective, consecutive, interventional case series.


METHODS
Eighteen patients diagnosed with neovascular AMD that were refractory to anti-VEGF therapy and received alternating biweekly ranibizumab/bevacizumab injections were included.


METHODS
Patients with neovascular AMD and PED that were refractory to at least 11 monthly ranibizumab or bevacizumab injections were included in this study at a large, single retina practice. Following inclusion, patients received four bi-weekly alternating ranibizumab/bevacizumab intravitreal injections. After completing a course of four bi-weekly injections, patients were treated with variable regimens of intravitreal anti-vascular endothelial growth factor (VEGF) therapy. The primary outcomes of the study included change in visual acuity (VA) and central foveal thickness (CFT) at eight weeks follow-up.


RESULTS
Study eyes had previously received a mean of 22 intravitreal anti-VEGF injections. At enrollment, mean VA was 20/95 and mean CFT was 455 µm. After four bi-weekly anti-VEGF injections, mean VA improved to 20/65 (p < 0.001), and mean CFT decreased to 387 µm (p = 0.029). In patients with PED, there was a mean 27.9% reduction in height (p = 0.046) at eight weeks' follow-up.


CONCLUSIONS
Four injections of bi-weekly alternating ranibizumab/bevacizumab improved visual acuity and reduced macular thickness in a number of patients with refractory neovascular AMD and PED.
a Tufts Medical Center , Department of Ophthalmology , Boston , MA , USA.
Andre J
AJ
Witkin
b Mid Atlantic Retina, The Retina Service of Wills Eye Hospital , Philadelphia , PA , USA.
Nadim
N
Rayess
b Mid Atlantic Retina, The Retina Service of Wills Eye Hospital , Philadelphia , PA , USA.
Sunir J
SJ
Garg
b Mid Atlantic Retina, The Retina Service of Wills Eye Hospital , Philadelphia , PA , USA.
Joseph I
JI
Maguire
b Mid Atlantic Retina, The Retina Service of Wills Eye Hospital , Philadelphia , PA , USA.
Philip
P
Storey
b Mid Atlantic Retina, The Retina Service of Wills Eye Hospital , Philadelphia , PA , USA.
Richard S
RS
Kaiser
b Mid Atlantic Retina, The Retina Service of Wills Eye Hospital , Philadelphia , PA , USA.
Jason
J
Hsu
b Mid Atlantic Retina, The Retina Service of Wills Eye Hospital , Philadelphia , PA , USA.
James F
JF
Vander
b Mid Atlantic Retina, The Retina Service of Wills Eye Hospital , Philadelphia , PA , USA.
Allen C
AC
Ho
D020533:Angiogenesis Inhibitors / Q000008:administration & dosage; D000068258:Bevacizumab / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D006801:Humans; D058449:Intravitreal Injections; D000069579:Ranibizumab / Q000008:administration & dosage*; D012160:Retina / Q000000981:diagnostic imaging; D012163:Retinal Detachment / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence / Q000379:methods*; D016896:Treatment Outcome; D014792:Visual Acuity; D057135:Wet Macular Degeneration / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*
D020533:Angiogenesis Inhibitors; D000068258:Bevacizumab; D000069579:Ranibizumab
Bevacizumab; bi-weekly; neovascular age-related macular degeneration; pigment epithelial detachment; ranibizumab, refractory