Intravitreal ranibizumab and bevacizumab therapy for choroidal neovascularization in age-related macular degeneration with extensive pre-existing geographic atrophy

Abstract

Purpose: To report the response of choroidal neovascularization to intravitreal ranibizumab or bevacizumab treatment in the setting of age-related macular degeneration with extensive pre-existing geographic atrophy of the retinal pigment epithelium. Methods: This is a retrospective case series of 11 eyes in ten consecutive patients retrieved from a photographic database. The patients were treated with ranibizumab or bevacizumab for neovascular age-related macular degeneration with pre-exis ting geographic atrophy. Patients were included if they had geographic atrophy at or adjacent to the foveal center of at least 1 disc area in size that was present before the development of choroidal neovascularization. The best corrected visual acuity and optical coherence tomography analysis of the central macular thickness were recorded for each visit. Serial injections of ranibizumab or bevacizumab were administered until there was complete resolution of subretinal fluid on optical coherence tomography. Data over the entire follow-up period were analyzed for overall visual and optical coherence tomography changes. Results: The patients received an average of 7 ± 3 intravitreal injections over the treatment period. Seven of 11 eyes had reduced retinal thickening on optical coherence tomography. On average, the central macular thickness was reduced by 72 ± 115 µm. Six of these 7 eyes had improvement of one or more lines of vision and one had no change. The average acuity change for all patients was -0.04 ± 0.46 logMAR units, which corresponded to a gain of 0.2 ± 4.4 lines of Snellen acuity. The treatment resulted in a good anatomic response with resolution of the subretinal fluid and overall stable visual acuity. Conclusions:The results of this case series suggest that the use of an intravitreal anti-vascular endothelial growth factor (VEGF) agent (ranibizumab or bevacizumab) for choroidal neovascularization in age-related macular degeneration with preexis ting geographic atrophy is effective. Our results are not as striking as published results from large-scale trials of anti-vascular endothelial growth factor therapy for subfoveal choroidal neovascularization, presumably due to the limitation in the baseline visual acuity caused by the underlying geographic atrophy. The favorable anatomic response with the resolution of subretinal fluid and stable acuity were consistent with other ranibizumab and bevacizumab studies.Keywords: Macular degeneration; Geographic atrophy; Retinal pigment epithelium, Choroidal neovascularization; Antibodies, monoclonal/therapeutic use; Retina; Antibodies, monoclonal, humanized; Tomography, optical coherence Intravitreal ranibizumab and bevacizumab therapy for choroidal neovascularization in age-related macular degeneration with extensive pre-existing geographic atrophy Avaliação da resposta da injeção intravítrea de ranibizumab e bevacizumab em pacientes com neovascularização de coroide da degeneração macular relacionada à idade com atrofia geográfica extensa pré-existente

Age-related macular degeneration with choroidal neovascularization in the setting of pre-existing geographic atrophy and ranibizumab treatment. Analysis of a case series and revision paper

“…Eight of our 10 patients improved their vision with ranibizumab treatment for CNV in AMD with extensive pre-existing GA and reports of ranibizumab treatment of choroidal neovascularization in the setting of pre-existing Geographic Atrophy from AMD (24,25) with similar results as: good anatomic response with disappearance of the subretinal fluid, improved visual acuity and stabilized final visual results consistent with others ranibizumab studies (11,12,24,25) . …”

Geographic Atrophy and Choroidal Neovascularization in the Same Eye: A Review

“…Favorable anatomical and visual function outcomes were found after treatment with either ranibizumab or bevacizumab. However, Amaro et al mentioned that the improvement in visual acuity in their study was not as remarkable as in other anti-VEGF trials, incriminating underlying GA [62]. Querques et al found that treatment of CNV with ranibizumab in eyes with concomitant GA resulted in significant reduction of the morphological manifestations of CNV at 24 months of treatment in 21 naïve eyes; however, visual acuity deteriorated, perhaps because the underlying GA prevented any favorable outcome in visual function [63].…”

“…Currently, there are 3 medications in widespread use: bevacizumab (Avastin; Genentech, Inc., South San Francisco, CA), ranubizumab (Lucentis; Genentech, Inc., South San Francisco, CA), and aflibercept (Eyelea; Regeneron, Inc., Tarrytown, NY). Anti-VEGF injections were recently studied for their efficacy in treating CNV with underlying GA. Amaro et al studied the effect of anti-VEGF treatment on the combined GA/CNV phenotype in a case series of 11 eyes [62]. Favorable anatomical and visual function outcomes were found after treatment with either ranibizumab or bevacizumab.…”

Inhibition of AMD-Like Pathology With a Neurotrophic Compound in Aged Rats and 3xTg-AD Mice

“…Excessive amounts of vascular endothelial growth factor (VEGF) is a major pathological change in wet AMD, and anti-VEGF can relieve or delay the progress of wet AMD (Xu et al, 2015; Wang et al, 2016). Anti-VEGF treatment of the combined dry/wet AMD phenotype was reported to be effective in a case series of 11 eyes (Amaro and Roller, 2012). In the present study, we found that VEGF-positive spots were located mainly in the inner retinal layers from the NFL to the IPL and in the RPE in young mice, but they were more widely distributed in the INL, OPL, and ONL in aged mice and less so in the RPE in aged WT-21 m/Veh and 3xTg-21 m/Veh mice (Supplementary Figure S6).…”