Evaluation of plasma vascular endothelial growth factor levels after intravitreal injection of ranibizumab and aflibercept for exudative age-related macular degeneration

To evaluate the plasma vascular endothelial growth factor (VEGF) levels after one intravitreal injection of aflibercept or ranibizumab in patients with exudative age-related macular degeneration (AMD). Twenty-four Japanese with exudative AMD, polypoidal choroidal vasculopathy, and retinal angiomatous proliferation were included. Fourteen patients received an intravitreal injection of aflibercept, and ten patients received an intravitreal injection of ranibizumab. Plasma VEGF levels were evaluated within 7 days before the intravitreal injections and 1 day, 1 week, and 1 month after the intravitreal injection. In the ranibizumab group, the mean plasma VEGF levels were 245.7 +/- 233.4 pg/ml before the injection, 246.6 +/- 304.8 pg/ml after 1 day, 217.8 +/- 212.9 pg/ml after 1 week, and 260.0 +/- 290.1 pg/ml after 1 month. The plasma VEGF levels did not decrease significantly in patients in the ranibizumab group at any time point. In the aflibercept group, the mean plasma VEGF levels were 280.0 +/- 170.3 pg/ml before the intravitreal injection and 8.2 +/- 12.9 pg/ml after 1 day, 9.1 +/- 9.1 pg/ml after 1 week, and 41.9 +/- 41.4 pg/ml after 1 month (p < 0.0001, vs before injection). Intravitreally injected aflibercept reduced plasma VEGF over at least 1 month. In contrast, intravitreal injection of ranibizumab did not cause a significant reduction in the plasma VEGF levels.