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Abstract
Purpose
To investigate the difference of optical coherence tomography (OCT) findings between the aflibercept treatment group and the ranibizumab treatment group.
Methods
This study includes patients diagnosed with treatment-naïve neovascular age-related macular degeneration (AMD), and they were treated with aflibercept (n = 23, 23 eyes) or ranibizumab (n = 26, 26 eyes) monthly for 3 months. In this study, the aflibercept treatment group patients were treated from March 2014 to April 2015, and the ranibizumab treatment group patients were treated from December 2008 to April 2015. After three initial injections, they were followed up monthly for an additional 3 months, and additional treatments were performed if necessary. We compared the changes of the two groups before the treatment and after 6 months of treatment, beginning with the OCT findings, such as serous pigment epithelium detachment, fibrovascular pigment epithelium detachment, subretinal fluid, intraretinal fluid, dense zone of outer retina, classic neovascularization, and hyper-reflective dots. We also compared the changes of best corrected visual acuity (BCVA) and inner segment/outer segment (IS/OS) length, external limiting membrane length, and central foveal thickness with optical OCT between the two groups.
Results
In the aflibercept group, 46% of serous epithelial detachments disappeared, while 33% disappeared in the ranibizumab group, and there was significant difference between the two groups (p = 0.01). There was no significant difference in BCVA change or OCT findings between the two groups, but there was a significant difference in serous pigment epithelium detachment.
Conclusions
For treatment of neovascular AMD patients, aflibercept might be more effective in serous pigment epithelium detachment than ranibizumab. Because there was no significant difference in visual acuity improvement in serous pigment detachment for both treatments, it might be necessary to further study the relationship between visual acuity and serous pigment detachment improvement.
References
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Figure 1.
Spectral domain optical coherence tomography images (SD-OCT). (A) Before the treatments, serous pigment epithelium detachment (S-PED); subretinal fluid (SRF); hyper-reflective dots (H-dots) were found on the SD-OCT images. (B) After 6 month of treatment, S-PED and SRF disappeared on the SD-OCT images. (C) Before the treatments, Intraretinal fluid (IRF); Dense Zone of the outer retina (D-zone); classic choroidal neovascularization (C-CNV); hyper-reflective dots (H-dots); fibrovascular pigment epithelium detachment (FV-PED) were found on the SD-OCT images. (D) After 6 months of treatment, IRF, D-zone, C-CNV, H-dots, FV-PED disappeared on the SD-OCT images.
Figure 2.
The inner and outer segment junction (IS/OS) and external limiting membrane (ELM) in Spectral domain optical coherence tomography. These lines were measured within 1 mm from the central fovea. The dashed black arrows indicate the ELM lines, and the dashed white arrows indicate the IS/OS line.
Table 1.
Baseline demographics and ocular characteristics of the two treatment groups
| Aflibercept group | Ranibizumab group | p-value | |
|---|---|---|---|
| Study population (n) | 23 (23 eyes) | 26 (26 eyes) | |
| Gender (male:female) | 12:11 | 16:10 | 0.527* |
| Age (years) | 68.95 ± 8.45 | 68.61 ± 9.88 | 0.880† |
| Mean baseline BCVA (log MAR) | 1.17 ± 0.46 | 0.90 ± 0.41 | 0.101† |
| Intravitreal injections after 3 loading injections (times) | 0.47 ± 0.66 | 0.88 ± 0.86 | 0.346† |
Table 2.
Comparison of best corrected visual acuity between aflibercept group and ranibizumab group
| Initial (log MAR) | Aflibercept group 1.17 ± 0.46 | Ranibizumab group 0.90 ± 0.41 | p-value 0.101* |
|---|---|---|---|
| Post-treatment (log MAR) | 0.94 ± 0.48 | 0.74 ± 0.39 | 0.222* |
| p-value (log MAR) | 0.763* | 0.289* |
Table 3.
Comparison of optical coherence tomography (OCT) findings between aflibercept group and ranibizumab group
| Aflibercept group | Ranibizumab group | p-value | ||
|---|---|---|---|---|
| S-PED (n, %) | Initial | 15/23 (47) | 6/26 (23) | 0.127* |
| Post-treatment | 8/23 (34) | 4/26 (15) | 0.041* | |
| Improvement | 7/15 (46) | 2/6 (33) | 0.010* | |
| FV-PED (n, %) | Initial | 9/23 (39) | 14/26 (53) | 0.581* |
| Post-treatment | 3/23 (13) | 8/26 (30) | 0.102* | |
| Improvement | 6/9 (66) | 4/14 (28) | 0.102* | |
| C-CNV (n, %) | Initial | 11/23 (47) | 23/26 (88) | 0.152* |
| Post-treatment | 3/23 (13) | 8/26 (30) | 1.000* | |
| Improvement | 8/11 (72) | 15/23 (65) | 1.000* | |
| SRF (n, %) | Initial | 20/23 (86) | 24/26 (92) | 0.126* |
| Post-treatment | 6/23 (26) | 8/26 (30) | 0.537* | |
| Improvement | 14/20 (70) | 16/24 (66) | 1.000* | |
| IRF (n, %) | Initial | 20/23 (86) | 24/26 (92) | 0.126* |
| Post-treatment | 6/23 (24) | 8/26 (30) | 0.627* | |
| Improvement | 14/20 (70) | 16/24 (66) | 0.537* | |
| D-zone (n, %) | Initial | 8/23 (34) | 24/26 (92) | 0.069* |
| Post-treatment | 4/23 (17) | 0/26 (0) | 0.487* | |
| Improvement | 4/8 (50) | 24/24 (100) | 0.487* | |
| H-dot (n, %) | Initial | 11/23 (47) | 14/26 (53) | 0.418* |
| Post-treatment | 8/23 (34) | 9/26 (34) | 1.000* | |
| Improvement | 3/11 (27) | 5/19 (26) | 1.000* | |
| IS/OS length (μ m) | Initial length | 465.78 ± 532.23 | 565.65 ± 583.93 | 0.429† |
| Post-treatment length | 986.69 ± 696.02 | 920.76 ± 749.51 | 0.856† | |
| Change | 506.26 ± 712.71 | 332.15 ± 585.80 | 0.094† | |
| ELM length (μ m) | Initial length | 815.82 ± 683.91 | 1,033.65 ± 678.51 | 0.274† |
| Post-treatment length | 1,181.34 ± 767.31 | 1,435.88 ± 695.58 | 0.316† | |
| Change | 342.34 ± 693.18 | 389.03 ± 776.45 | 0.952† | |
| CFT (μ m) | Initial length | 311.00 ± 104.06 | 312.88 ± 82.31 | 0.904† |
| Post-treatment length | 223.56 ± 68.40 | 234.37 ± 53.65 | 0.489† | |
| Change | –87.34 ± 95.24 | –78.50 ± 74.74 | 0.555† |
Values are presented as mean ± SD unless otherwise indicated. S-PED = serous pigment epithelium detachment; FV-PED = fibrovascular pigment epithelium detachment; C-CNV = classic choroidal neovascularization; SRF = subretinal fluid; IRF = intraretinal fluid; D-zone = dense zone of the outer retina; H-dot = hyper-reflective dots; IS/OS length = length of the intact inner and outer segment junction; ELM length = length of the intact external limiting membrane; CFT = central foveal thickness.
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