title: Comparison of anti-VEGF therapies on fibrovascular pigment epithelial detachments in age-related macular degeneration.
abstract: The aim is to compare the therapeutic effects of three antivascular endothelial growth factor (VEGF) drugs (bevacizumab, aflibercept and ranibizumab) on fibrovascular pigment epithelial detachments (fvPEDs) in age-related macular degeneration (AMD).
  
  
  
  This was a retrospective, comparative, consecutive case series of 88 unique eyes with fvPEDs in neovascular AMD treated with anti-VEGF monotherapy for a minimum of 6 months. All eyes were treatment naive. Diagnosis was confirmed retrospectively by fluorescein angiography and spectral-domain optical coherence tomography. Exclusion criteria included serous/drusenoid PEDs or patients who switched anti-VEGF. Mean follow-up across all therapies was 313.9±85.3 days.
  
  
  
  Average age of all patients was 80.6 years. Baseline maximum subfoveal PED height was 326.8±185.1 μm, 394.5±238.6 μm and 258.0±145.3 μm for bevacizumab, aflibercept and ranibizumab, respectively (p=0.05). All patients had subretinal fluid, intraretinal fluid or a combination of the two at an initial presentation. Central retinal thickness decreased at all time points compared with baseline across all three anti-VEGF therapies. Subfoveal PED height decreased in patients treated with aflibercept at all time points and decreased in patients treated with bevacizumab at 1-month, 3-month and 6-month time points. Aflibercept reduced PED height more than bevacizumab at 1-month and 12-month follow-ups (p=0.02 and p=0.03, respectively) and ranibizumab at 1-month and 6-month follow-ups (p=0.03 and p=0.02, respectively). No differences in best-corrected visual acuity were appreciated at any time point between drugs.
  
  
  
  There was a significant reduction in subfoveal PED height for aflibercept and bevacizumab compared with baseline. A direct comparison of drugs demonstrated a beneficial reduction of PED height, albeit inconsistently, favouring aflibercept. There were no differences in visual acuity across the groups at any time point.
authors.affiliation: Case Western Reserve School of Medicine, Cleveland, Ohio, USA.
authors.forename: Adrian
authors.initials: A
authors.lastname: Au
authors.affiliation: Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
authors.forename: Vishal S
authors.initials: VS
authors.lastname: Parikh
authors.affiliation: Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
authors.forename: Rishi P
authors.initials: RP
authors.lastname: Singh
authors.affiliation: Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
authors.forename: Justis P
authors.initials: JP
authors.lastname: Ehlers
authors.affiliation: Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
authors.forename: Alex
authors.initials: A
authors.lastname: Yuan
authors.affiliation: Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
authors.forename: Aleksandra V
authors.initials: AV
authors.lastname: Rachitskaya
authors.affiliation: Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
authors.forename: Jonathan E
authors.initials: JE
authors.lastname: Sears
authors.affiliation: Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
authors.forename: Sunil K
authors.initials: SK
authors.lastname: Srivastava
authors.affiliation: Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
authors.forename: Peter K
authors.initials: PK
authors.lastname: Kaiser
authors.affiliation: Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Schachat
authors.affiliation: Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
authors.forename: Daniel F
authors.initials: DF
authors.lastname: Martin
authors.affiliation: Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
authors.forename: Yasha
authors.initials: Y
authors.lastname: Modi
mesh_terms: D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage; D000068258:Bevacizumab / Q000008:administration & dosage*; D057915:Drug Substitution; D005260:Female; D005451:Fluorescein Angiography / Q000379:methods; D005654:Fundus Oculi; D006801:Humans; D058449:Intravitreal Injections; D008297:Male; D000069579:Ranibizumab / Q000008:administration & dosage*; D040262:Receptors, Vascular Endothelial Growth Factor / Q000008:administration & dosage*; D011993:Recombinant Fusion Proteins / Q000008:administration & dosage*; D012163:Retinal Detachment / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence / Q000379:methods; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors*; D014792:Visual Acuity; D057135:Wet Macular Degeneration / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*
chemical_list: D020533:Angiogenesis Inhibitors; D011993:Recombinant Fusion Proteins; D042461:Vascular Endothelial Growth Factor A; C533178:aflibercept; D000068258:Bevacizumab; D040262:Receptors, Vascular Endothelial Growth Factor; D000069579:Ranibizumab
keywords: Drugs; Neovascularisation; Pathology; Retina