BACKGROUND: This study aimed to investigate the trend of selecting ranibizumab and aflibercept for the initial treatment of neovascular age-related macular degeneration (AMD) and polypoidal choroidal vasculopathy (PCV). METHODS: This was a retrospective study that included 460 patients who were diagnosed with treatment-naïve neovascular AMD and PCV and were initially treated with either ranibizumab or aflibercept. The patients were divided into two groups: the ranibizumab group (n = 96) and the aflibercept group (n = 324). The patients’ characteristics and the proportion of the subtypes of macular neovascularization (MNV) were compared between the two groups. RESULTS: Patients in the ranibizumab group were significantly older (mean 74.3 ± 8.4 years) than those in the aflibercept group (mean 70.4 ± 8.8 years; p < 0.001). In the ranibizumab group, the proportions of type 1 or 2 MNV, type 3 MNV, and PCV were 50.0%, 27.1%, and 22.9%, respectively. In the aflibercept group, the proportions were 35.2%, 6.8%, and 58.0%, respectively. There was a significant difference in the proportion of MNV subtypes between the ranibizumab and aflibercept groups (p < 0.001). Ranibizumab was used in 54.2% of patients with type 3 MNVs. However, in patients with PCV, aflibercept was used in 89.5% of patients. CONCLUSIONS: Ranibizumab was preferred as an initial treatment agent in older patients and those with type 3 MNV, whereas aflibercept was highly preferred in patients with PCV. The different characteristics and efficacy of the two agents may have partially contributed to this trend.
Background: To evaluate the short-term outcomes of switching to ranibizumab in aflibercept-resistant polypoidal choroidal vasculopathy (PCV). Methods: This retrospective study included 18 eyes diagnosed with aflibercept-resistant PCV. All patients were treated with two to four consecutive ranibizumab injections at 4–5-week intervals. The best-corrected visual acuity (BCVA), and central retinal thickness (CRT) values before and after switching to ranibizumab were compared. The proportion of eyes showing ≥100 µm decrease in retinal thickness and/or complete resolution of fluid after switching was identified. Results: The mean number of aflibercept injections before switching was 5.7 ± 3.3. After switching, a mean of 2.8 ± 0.6 consecutive ranibizumab injections was performed. The mean logarithm of minimal angle of resolution (logMAR) BCVA was 0.41 ± 0.26 (Snellen equivalents = 20/51) before switching, and 0.40 ± 0.30 (20/50) after switching (p = 0.574). The mean CRT was 422.2 ± 152.4 µm before switching, and 400.7 ± 182.0 µm after switching (p = 0.236). A decrease in CRT of ≥100 µm, and/or complete resolution of fluid was noted in three eyes (16.7%). Conclusions: Switching to ranibizumab in aflibercept-resistant polypoidal choroidal vasculopathy was not effective in most patients, suggesting the need for further investigation to seek more effective treatment options for this condition.
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