PURPOSE: To evaluate the efficacy of 3 bimonthly aflibercept injections for neovascular age-related macular degeneration (AMD) that showed limited response to 3 initial ranibizumab injections. METHODS: Three bimonthly aflibercept injections were performed for 21 eyes with neovascular AMD that was refractory to 3 monthly ranibizumab injections. Best-corrected visual acuity (BCVA) and central retinal thickness (CRT) were measured at diagnosis, 1 month after 3 ranibizumab injections, and 1 month after 3 aflibercept injections, and these values were compared. RESULTS: The mean logarithm of minimal angle of resolution (logMAR) BCVA at diagnosis, after ranibizumab therapy, and after aflibercept therapy was 0.62 ± 0.29, 0.73 ± 0.31, and 0.65 ± 0.28, respectively. The CRT at the aforementioned times was 427.0 ± 98.7 µm, 409.5 ± 78.7 µm, and 315.9 ± 98.2 µm, respectively. When compared with the value measured after ranibizumab therapy, CRT was significantly decreased after aflibercept therapy (p < 0.001), whereas there was no significant difference in BCVA (p = 0.092) between the two times. Improved BCVA was noted in 8 eyes (38.1%) after aflibercept therapy and BCVA was unchanged in 11 eyes (52.4%). Decreased CRT was noted in 18 eyes (85.7%) after aflibercept therapy. CONCLUSIONS: Three bimonthly aflibercept injections were found to be useful in terms of improving or maintaining visual acuity, as well as reducing retinal thickness in neovascular AMD that showed limited response to 3 initial ranibizumab injections.
Diagnosis ; Macular Degeneration* ; Ranibizumab* ; Retinaldehyde ; Visual Acuity

PURPOSE: To compare the changes in subfoveal choroidal thickness between intravitreal aflibercept and ranibizumab injection in wet age-related macular degeneration (AMD). METHODS: Fifty patients with wet AMD patients who were treated with aflibercpet or ranibizumab were evaluated retrospectively. All patients were treated with pro re nata after 3 consecutive monthly injections and were followed up for at least 6 months. We measured subfoveal choroidal thickness (SFCT) using enhanced depth imaging spectral-domain optical coherence tomography before the first injection and 1, 2, 3, and 6 months after initial injection. RESULTS: The SFCT measures before initial injection and 1, 2, 3, and 6 months after initial injection were 244.94 ± 103.77 µm, 219.04 ± 95.89 µm, 208.74 ± 91.03 µm, 203.64 ± 91.35 µm, and 226.98 ± 96.79 µm in the aflibercept group (25 eyes) and 222.68 ± 102.04 µm, 210.23 ± 95.91 µm, 203.66 ± 99.39 µm, 197.27 ± 100.25 µm, and 210.32 ± 111.86 µm in the ranibizumab group (28 eyes). Mean change in SFCT was greater in the aflibercept group at 1 month, 2 months, and 3 months after initial injection (p < 0.05), but there was no significant difference in the mean change in SFCT between the two groups at 6 months after initial injection (p > 0.05). CONCLUSIONS: The decrease in SFCT was greater after aflibercept injection than ranibizumab injection in 3 consecutive months. However, at 6 months after initial injection, the difference in the change in SFCT was not significant.
Choroid* ; Humans ; Macular Degeneration* ; Ranibizumab* ; Retrospective Studies ; Tomography, Optical Coherence

PURPOSE: To evaluate the 6-month outcomes of intravitreal ranibizumab and aflibercept treatment for patients with retinal angiomatous proliferation (RAP). METHODS: A retrospective review of medical records of 28 patients (31 eyes) diagnosed with RAP was performed. All patients were initially treated with 3 consecutive intravitreal ranibizumab or aflibercept injections after diagnosis. Additional treatment was performed when exudation recurred. The best-corrected visual acuity (BCVA) and central foveal thickness were measured before the first injection and 3 and 6 months after the first injection. The values measured before the treatment were compared with those after treatment. RESULTS: Sixteen eyes were treated with ranibizumab and 15 eyes with aflibercept. The logarithm of minimal angle of resolution (log MAR) values of BCVA before the first injection and 3 and 6 months after the first injection were 0.78 +/- 0.50, 0.47 +/- 0.30 and 0.59 +/- 0.41 in the ranibizumab group and 0.96 +/- 0.52, 0.83 +/- 0.52 and 0.74 +/- 0.56 in the aflibercept group, respectively. Central foveal thickness was 315.75 +/- 115.44, 188.38 +/- 57.33 and 218.50 +/- 96.49 microm in the ranibizumab group and 249.00 +/- 74.88, 143.73 +/- 32.73 and 196.73 +/- 94.08 microm in the aflibercept group, respectively. BCVA was significantly improved and central foveal thickness was significantly reduced at 6 months (p < 0.05) compared to measurements before the first injection in both groups. However, BCVA improvement and central foveal thickness were not significantly different between the 2 groups. CONCLUSIONS: Both intravitreal ranibizumab and aflibercept treatments were beneficial for both normalizing macular thickness and improving visual acuity in patients with RAP. The efficacy of the 2 drugs was not noticeably different.
Diagnosis ; Humans ; Medical Records ; Retinaldehyde* ; Retrospective Studies ; Visual Acuity ; Ranibizumab

PURPOSE: To evaluate outcomes of intravitreal aflibercept in cases resistant to bevacizumab and ranibizumab in neovascular age-related macular degeneration. METHODS: Twenty patients with neovascular age-related macular generation who were resistant to treatment with bevacizumab and ranibizumab were evaluated. After switching to aflibercept the best corrected visual acuity (BCVA) and central retinal thickness (CRT) were compared at baseline and at 1 month after injection. Additionally, changes in the intraretinal fluid, subretinal fluid and pigment epithelial detachment were evaluated. RESULTS: The mean BCVA was 0.83 +/- 0.56 log MAR and the mean CRT was 294.20 +/- 12.99 microm before aflibercept treatment. After switching to aflibercept the mean BCVA was 0.86 +/- 0.61 log MAR with no statistical difference (p = 0.406) and the mean CRT was decreased to 232.45 +/- 12.05 microm (p = 0.011). After 1 month of aflibercept injections, a reduction of intraretinal fluid in 4 eyes (80%), reduction of subretinal fluid in 11 eyes (78.6%) and reduction of pigment epithelial detachment in 5 eyes (50%) were observed. Increases in fluid or new lesions were not observed. CONCLUSIONS: Aflibercept injection appears beneficial in patients with neovascular age-related macular generation who are resistant to bavacizumab and ranibizumab treatment.
Humans ; Macular Degeneration* ; Retinaldehyde ; Subretinal Fluid ; Visual Acuity ; Bevacizumab ; Ranibizumab

PURPOSE: To compare the effects of bevacizumab and ranibizumab on the expression of eNOS in cultured human trabecular meshwork cells (HTMC). METHODS: Primarily cultured HTMC were exposed to 0.5 mg/mL bevacizumab and ranibizumab using 1% serum-containing media for 30 minutes. Expression of eNOS mRNA was assessed with RT-PCR. Additionally, after exposure to 20 ng/mL of vascular endothelial growth factor (VEGF) and 0.5 mg/mL bevacizumab and ranibizumab, the production of nitric oxide was assessed with Griess assay. RESULTS: VEGF increased the production of nitric oxide in HTMC. Bevacizumab and ranibizumab decreased the expression of eNOS mRNA and production of nitric oxide (p < 0.05) in HTMC. The decrease in eNOS mRNA expression and production of nitric oxide was not significant between bevacizumab and ranibizumab (p > 0.05). CONCLUSIONS: In HTMC, both bevacizumab and ranibizumab decreased the expression of eNOS mRNA with no significant difference observed between the two drugs.
Humans ; Nitric Oxide ; RNA, Messenger ; Trabecular Meshwork* ; Vascular Endothelial Growth Factor A ; Bevacizumab ; Ranibizumab

PURPOSE: To compare the short-term efficacy of intravitreal aflibercept and ranibizumab treatment according to the subtypes of polypoidal choroidal vasculopathy (PCV) based on indocyanine green angiography (ICGA). METHODS: Fifty-five treatment naïve patients with PCV who underwent intravitreal anti-vascular endothelial growth factor (VEGF) (ranibizumab, 26 eyes; aflibercept, 29 eyes) injection were retrospectively analyzed. Based on ICGA, subjects with feeder and draining vessels were defined as type 1 PCV (33 eyes), and subjects who did not have either feeder or draining vessels, but had branch vascular networks were defined as type 2 PCV (22 eyes). The complete polyp regression was assessed at 3 months after the initial treatment using ICGA. Changes in best-corrected visual acuity (BCVA) and optical coherence tomographic parameters were evaluated at 3 and 6 months. RESULTS: Patients with type 1 PCV showed a higher complete polyp regression percentage (p = 0.034) and better visual improvement (p = 0.017) after three monthly injections compared to patients with Type 2 PCV. At 3 and 6 months, the BCVA was significantly improved in type 1 PCV patients, but not in type 2 PCV patients. In patients with type 1 PCV, the aflibercept-treated group showed a better response in anatomical outcomes (p = 0.020), and complete polyp regression percentage (p = 0.027; dry macula) than the ranibizumab-treated group, and only the aflibercept-treated group showed a significant improvement of BCVA at 3 and 6 months. In patients with type 2 PCV, there were no significant differences in visual and anatomical outcome between the anti-VEGF agents. CONCLUSIONS: Type 1 PCV showed better visual improvement with a higher percentage of polyp regression than type 2 PCV. Anatomical changes were greater in patients treated with aflibercept than with ranibizumab, particularly in patients with type 1 PCV. These results suggest that a consideration of angiographic features is important in establishing a treatment strategy for patients with PCV.
Angiography ; Choroid* ; Classification* ; Endothelial Growth Factors ; Humans ; Indocyanine Green ; Polyps ; Ranibizumab* ; Retrospective Studies ; Visual Acuity

PURPOSE: To evaluate the effect of intravitreal injection on the corneal endothelium according to the injected drug. METHODS: The present study included 118 eyes of 113 patients who received intravitreal injection. Before each injection and 1 month after the injection, specular microscopy was performed to evaluate the corneal endothelial changes and central corneal thickness. We classified the patients according to the injected drug (bevacizumab 21 eyes, ranibizumab 20 eyes, aflibercept 47 eyes, dexamathasone implant 30 eyes), phakic or pseudophakic eyes, single or multiple injections and analyzed them retrospectively. RESULTS: The mean corneal endothelial cell density was 2,693.2 ± 298.2 cells/mm² before injection and 2,686.8 ± 288.7 cells/mm² 1 month after injection, and there was no statistically significant difference (p = 0.731). According to the kind of drug, the mean corneal endothelial cell density and central corneal thickness were not significantly different before and 1 month after injection in any of the 4 groups. CONCLUSIONS: There were no significant changes in corneal endothelium before and 1 month after intravitreal injection of the various drugs.
Endothelial Cells ; Endothelium, Corneal* ; Humans ; Intravitreal Injections* ; Microscopy ; Ranibizumab ; Retrospective Studies

PURPOSE: To evaluate the 3-year visual and morphological outcomes of diabetic macular edema (DME) based on the morphological pattern observed on optical coherence tomography (OCT) after intravitreal ranibizumab injections. METHODS: Thirty-two eyes of 32 patients with DME were classified according to the following OCT features: diffuse retinal thickening (DRT), cystoid macular edema (CME), and serous retinal detachment (SRD). All patients received 3 consecutive monthly intravitreal injections of 0.5 mg ranibizumab. After 3 injections, patients received ranibizumab or dexamethasone implantation as needed. The primary outcome was the number of treatments received based on the DME type over 36 months. Best-corrected visual acuity (BCVA), central subfoveal thickness, and macular volume changes were also evaluated. RESULTS: The eyes were classified as DRT (n = 16), CME (6), or SRD (10). The mean number of injections over 3 years was significantly different among the groups: DRT (4.25), CME (7.5), SRD (7.6; p = 0.048). The number of patients who did not need additional treatment after the initial 3 injections was 13 with DRT (81.3%), 2 with CME (33.3%), and 5 with SRD (50%; p = 0.045). BCVA at 36 months significantly improved from baseline in the DRT group (p = 0.003). The CME group showed the worst BCVA among the groups (p = 0.023). Six patients who received intravitreal dexamethasone implantation showed no significant improvement of BCVA but significant decrease in macular volume from 12 to 36 months. CONCLUSIONS: Clinical courses varied according to the morphological pattern of DME after intravitreal ranibizumab injection, and patients with DRT maintained visual and anatomical improvement with fewer injections over 36 months. Additional dexamethasone implantation showed limited effect in reducing macular edema with persistent macular cystic change, but no significant improvement in visual acuity.
Dexamethasone ; Humans ; Intravitreal Injections ; Macular Edema* ; Ranibizumab* ; Retinal Detachment ; Retinaldehyde ; Tomography, Optical Coherence ; Visual Acuity

PURPOSE: To evaluate the effects of intravitreal ranibizumab in myopic choroidal neovascularization (CNV). METHODS: Patients who underwent intravitreal ranibizumab injection for myopic CNV, and were followed up more than 6 months, and their records were retrospectively investigated. The best corrected visual acuity, central macular thickness, and leak in fluorescein angiography were compared at baseline, and at 1, 3, and 6 months after injection. RESULTS: Twenty-one eyes of 18 patients were evaluated. The mean best corrected visual acuity (logMAR) was 1.23+/-0.65, 0.96+/- 0.40, 0.95+/-0.67, and 0.83+/-0.58 at baseline, 1, 3, and 6 months, respectively (p<0.001, p=0.006, p=0.001). The mean central macular thickness was 233.42+/-65.55 microm, 204.14+/-65.29 micrometer, and 157.76+/-71.45 microm at baseline, 3, and 6 months, respectively (p<0.001). In fluorescein angiography at 6 months after injection, regression was observed in 12 eyes, and fibrosis in 9 eyes. CONCLUSIONS: Intravitreal ranibizumab injection for myopic CNV in Korean patients appeared to be effective, resulting in regression of lesion and improvement of visual acuity.
Antibodies, Monoclonal, Humanized ; Choroid ; Choroidal Neovascularization ; Eye ; Fibrosis ; Fluorescein Angiography ; Humans ; Retrospective Studies ; Visual Acuity ; Ranibizumab

PURPOSE: To compare changes in choroidal hyperpermeability after half-energy photodynamic therapy (PDT) and intravitreal ranibizumab in the treatment of chronic central serous chorioretinopathy (CSC). METHODS: Post-hoc analysis was performed in a randomized, controlled trial comparing half-energy PDT versus intravitreal ranibizumab for chronic CSC; during the experiments, the other treatment was available for salvage treatment if the original was unsuccessful at 3 months. A commercially available image analysis program (Adobe(R) Photoshop(R) CS6 [Adobe Systems, Inc., San Jose, CA]) was used for quantification of change in choriodal hyperpermeability on indocyanine green angiography after half-energy PDT or three consecutive intravitreal injections of ranibizumab. Post-treatment images were subtracted from pre-treatment images after adjustments were made to create images depicting the change in choroidal hyperpermeability with treatment. Integrated gray scale values per area in this image were used for analysis of change in choroidal hyperpermeability. RESULTS: The calculated change in choroidal hyperpermeability was significantly greater in the half-energy PDT group (17.36 +/- 8.74) than in the ranibizumab group (6.78 +/- 5.03) (p < 0.001). All eyes in the half-energy PDT group showed complete resolution of subretinal fluid, and no significant difference in change of choroidal hyperpermeability was found in eyes that received half-energy PDT as primary or salvage treatment. In the ranibizumab-treated group, subretinal fluid resolution was accomplished in 5 eyes, and these eyes showed a significantly larger decrease in choroidal hyperpermeability when compared with eyes showing poor response (10.31 +/- 4.00 vs. 2.74 +/- 2.16, p = 0.005). In the successfully treated eyes with ranibizumab, there was no significant difference in choroidal hypopermeability change when compared to half-energy PDT (p = 0.124). CONCLUSIONS: Using our novel method of analysis of change in choroidal hyperpermeability following treatment for chronic CSC, greater change was found in eyes with good response, and the superior outcome of half-energy PDT over ranibizumab may be attributed to greater influence on choroidal hyperpermeability.
Angiography ; Central Serous Chorioretinopathy* ; Choroid* ; Indocyanine Green ; Intravitreal Injections ; Photochemotherapy* ; Subretinal Fluid ; Ranibizumab