Intravitreal anti-VEGF therapy in neovascular age-related macular degeneration: Bevacizumab versus Ranibizumab

PURPOSE: To compare and review the effectiveness and safety of intravitreal injections of ranibizumab and bevacizumab for neovascular age-related macular degeneration. METHODS: We reviewed the clinical records of 125 consecutive patients with neovascular AMD, who had undergone intravitreal anti-VEGF injections during 2006 and 2007 at the University Clinic of Ophthalmology in Innsbruck, Austria, with a follow-up time range between 6 and 12 months aftr initial treatment. The study comprised three groups. The first group comprised patients, who received ranibizumab (n = 34). The second group patients, who received bevacizumab (n = 42) and the third group patients, who initally received ranibizumab followed by bevacizumab (n = 49). Reinjections were performed upon signs of disease activity assessed by persistence or increase of retinal edema as determined by slit lamp biomicroscopy, OCT or fluorescein angiography. RESULTS: In the ranibizumab group the baseline VA changed from 0.14 +/- 0.13 to 0.15 +/- 0.13 at 6 months, and 0.15 +/- 0.11 at the final examination at 12 months. Compared to baseline VA 9 (26.5%) patients at 3 months, 9 (26.5%) at 6 months and 5 (29.4%) at 12 months gained 3 or more lines. Patients, who lost three or more lines were 10 (29.1%) at 3 months of follow-up, 9 (26.5%) at 6 months and 4 (23.5%) at 12 months of follow-up. In the bevacizumab group the course of VA was 0.24 +/- 0.14 at baseline, 0.24 +/- 0.21 at 6 months, and 0.27 +/- 0.23 at 12 months of follow-up. Compared to baseline VA 6 (14.3%) patients at 3 months, 5 (11.9%) at 6 months and 2 (18.2%) at 12 months gained 3 or more lines. Patients, who lost more than 3 lines were 8 (19.0%) at 3 months of follow-up, 11 (26.2%) at 6 months and 1 (9.0%) at 12 months of follow-up. In the group of patients, who initially received ranibizumab and then bevacizumab the baseline visual acuity changed from 0.19 +/- 0.15 to 0.22 +/- 0.20 at 6 months, and 0.21 +/- 0.18 at the final examination at 12 months. Compared to baseline VA 11 (22.4%) patients at 3 months, 13 (26.5%) at 6 months and 6 (25%) at 12 months gained 3 or more lines. Patients, who lost more than 3 lines were 6 (12.2%) at 3 months of follow-up, 13 (26.5%) at 6 months and 6 (25.0%) at 12 months of follow-up. We denotated no significant increase or decrease of mean VA in all three groups which depicts an overall stabilization of VA. We denotated one case of apoplexia and one case of severe cardiac arrhythmia in the bevacizumab group. CONCLUSION: We found no statistically significant difference comparing the data of our ranibizumab and bevacizumab groups. Our results confirm that therapy of neovascular AMD based on an as-needed basis reinjection scheme with ranibizumab as well as bevacizumab is effective in stabilizing visual acuity.