Abstract and Introduction
Abstract
Purpose To compare the effectiveness of intravitreal injection of bevacizumab and ranibizumab in patients with treatment-naïve polypoidal choroidal vasculopathy (PCV).
Methods A total of 66 and 60 eyes of 121 consecutive patients who received intravitreal bevacizumab (1.25 mg) or ranibizumab (0.5 mg) injection for treatment of PCV were retrospectively reviewed. After initial three loading injections by month, injection was performed as needed. Main outcome measures included best corrected visual acuity (BCVA), foveal center thickness (FCT) as assessed by spectral domain optical coherence tomography (SD-OCT), and change in polypoidal lesion on indocyanine green angiography (ICGA).
Results At 12 months, average number of injections was 4.72±1.84 in the bevacizumab group and 5.52±1.54 in the ranibizumab group. Mean logarithm of the minimum angle of resolution of BCVA from baseline at 12 months after injection improved by 0.11 in the bevacizumab group (P=0.02) and by 0.14 in the ranibizumab group (P=0.01). Average FCT decreased from 368±62.48 to 298±40.77 μm in the bevacizumab group (P=0.01) and from 371±50.79 to 286±36.93 μm in the ranibizumab group (P=0.01). Polyp regression rate was 24.2% (16 eyes out of 66 eyes) in the bevacizumab group and 23.3% (14 eyes out of 60 eyes) in the ranibizumab group. There was no statistically significant difference in BCVA improvement achieved, FCT improvement achieved, and polyp regression rate between groups.
Conclusion Intravitreal injections of bevacizumab and ranibizumab have similar effects in stabilization of visual acuity, macular edema, and regression of polypoidal complex with PCV eyes.
Introduction
Polypoidal choroidal vasculopathy (PCV) is characterized by a branching vascular network with polypoidal-shaped choroidal vascular lesions that result in subretinal leakage, subretinal hemorrhage, and pigment epithelial detachment. When pathological changes associated with PCV are extended to the subfoveal area, visual prognosis may be poor. Sho et al reported that severe vision loss, caused by persistent serous detachment, atrophy of retinal pigment epithelium (RPE), and submacular hemorrhage was noted in 34.5% (38 of 110 eyes) of the PCV patients.
Currently, there are several effective methods of treatment for PCV. Photodynamic therapy (PDT) with verteporfin or intravitreal injection of anti-vascular endothelial growth factor (VEGF) has recently been administered for treatment of PCV eyes, and encouraging results have been reported.
Pathogenesis of PCV is not fully understood. However, VEGF may have a role in pathogenesis. Compared with normal controls, VEGF concentrations in the aqueous were found to be markedly increased in PCV eyes and strong expression of VEGF was observed in RPE cells of PCV specimens. These reports support the use of anti-VEGF treatment of PCV eyes.
Ranibizumab is a humanized anti-VEGF antibody that inhibits all forms of biologically active VEGF-A; treatment with ranibizumab appears to significantly decrease bleeding and exudation in PCV. Bevacizumab (a humanized full-length anti-VEGF antibody) also appears to have a treatment effect in PCV eyes. Kokame et al reported that continuous monthly intravitreal ranibizumab injection was well tolerated in PCV patients; in addition, patients showed stabilized vision and decreased macular edema.
Recently, equivalence in the therapeutic effect between bevacizumab and ranibizumab in neovascular age-related macular degeneration (AMD) was reported. However, to the best of our knowledge, there have been no reports on the differences between bevacizumab and ranibizumab for treatment of PCV. The purpose of this study is to determine whether or not there are differences between bevacizumab and ranibizumab for treatment of PCV.