Session Title: Vascular Diseases and Diabetic Retinopathy
Session Date/Time: Friday 18/09/2015 | 11:00-12:30
Paper Time: 11:08
First Author: : F.Pichi ITALY
Co Author(s): : P. Carrai E. Villani A. Lembo M. Morara A. Ciardella P. Nucci
PURPOSE:To evaluate the safety and efficacy of intravitreal bevacizumab, ranibizumab, pegaptanib or aflibercept administered on an as-needed basis or as a loading dose for the treatment of naïve myopic CNV.
A monocentric, prospective, randomized case series.
From January 2012 to December 2013, 200 eyes from 200 patients with myopic CNV were consecutively enrolled in this prospective, randomized case series. Eligible patients were randomized with a final allocation ratio of 1:1:1:1 to intravitreal injection of ranibizumab, bevacizumab, pegaptanib or aflibercept in 1 eye. A second round of randomization was performed inside each study group, and the patients were randomized 1:1 to one nonloading intravitreal baseline injection and to a loading dose of three monthly injections followed by PRN treatment. Recurrence was defined as evidence of leakage from a previously closed CNV or as a change in central retinal thickness of more than 50 µm.
Results were evaluated at 3,6,9 and 12 months for all 200 eyes. No statistically significant difference in the BCVA improvement was found between the 8 subgroups groups during follow-up (P value at 3, 6, 9,12 months > 0.05). Although all subgroups attained a significant improvement in CMT, the loading dose aflibercept subgroup achieved a faster CRT reduction. A significantly lower number of injections were administered in the PRN bevacizumab subgroup (2.5) compared with the PRN ranibizumab subgroup (4.7; P < 0.001). The mean number of PRN pegaptanib injections was 3.8, and none of patients in the pegaptamib load group met the re-treatment criterion during the entire follow-up period.
Intravitreal anti-VEGF and VEGF-trap agents administered on an as-per-needed basis over 12 months achieved stabilization of vision with >95% CNV closure rate, not inferior to a regimen of three monthly injections. Intravitreal bevacizumab achieved greater efficacy than ranibizumab in terms of the mean number of injections administered. Treatment starting with three monthly pegaptamib injections may achieve better functional outcomes with fewer retreatments compared with all others PRN treatments. The findings demonstrate that the selective inhibition of VEGF-165 isoform by IVP is an effective treatment for myopic choroidal neovascularization.