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Anti-VEGF benefits phakic, pseudophakic eyes with wet AMD
Average central macular thickness decreased and best corrected visual acuity improved, authors say.
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Intravitreal ranibizumab injections for neovascular age-related macular degeneration yielded similar outcomes in phakic and pseudophakic eyes, according to a study.
“In spite of several expected changes in the vitreous cavity after phacoemulsification, there was no difference of the therapeutic effect with intravitreal ranibizumab injection for neovascular AMD between phakic and pseudophakic eyes,” Han Joo Cho, MD, the corresponding author, said in an email interview.
Cho said phacoemulsification may spur complications in moderately or severely inflamed eyes.
“In the acute stage, phacoemulsification could worsen pre-existing inflammation or lead to disruption of the ocular-blood barrier,” he said. “In the chronic stage, posterior vitreous detachment (PVD) is a very important change. After phacoemulsification, PVD is accelerated and its incidence increases to 30% postoperatively. PVD can induce the formation of floaters or cause retinal tear or retinal detachment.”
Han Joo Cho
The study was published in Retina.
Patients and methods
The retrospective review included 110 patients with neovascular AMD; 75 eyes were phakic and 45 eyes were pseudophakic. Mean patient age was 72 years. Average follow-up was 18 months.
All patients received three monthly loading dose injections of Lucentis (ranibizumab, Genentech). Subsequent re-treatment was performed on an as-needed basis. Best corrected visual acuity, IOP, anterior chamber parameters and retinal images were assessed at 3, 6, 9 and 12 months.
The average number of injections was 3.87 in the phakic group and 3.62 in the pseudophakic group; the between-group difference was statistically insignificant, according to the researchers.
Baseline mean BCVA was 0.88 in the phakic group and 0.86 in the pseudophakic group.
Results and conclusions
At final follow-up, mean BCVA was 0.75 in the phakic group and 0.74 in the pseudophakic group. Both improvements were statistically significant (P = .01 in the phakic group and P = .02 in the pseudophakic group), but the between-group difference in visual gain was insignificant.
Average central macular thickness decreased significantly, from 561 μm to 419 μm in the phakic group and from 559 μm to 429 μm in the pseudophakic group. The between-group difference was insignificant.
Results showed no evidence of posterior capsule opacification or migration of vitreous in pseudophakic eyes, Cho said.
“To my knowledge, there is no evidence of vitreous migration into the capsular bag,” he said. “However, if an anterior hyaloid membrane is attached to the posterior capsule, it could induce posterior capsular opacity, and this would require Nd:YAG laser capsulotomy.”
There was also no evidence that anti-VEGF injection caused sustained IOP elevation or increased the risk of glaucoma, Cho said.
“Intravitreal anti-VEGF can induce transient or sustained elevation of intraocular pressure,” he said. “However, it is well-controlled by application of a topical anti-glaucoma agent. To date, apart from steroid agents, no anti-VEGF agents have shown the potential to cause glaucoma. However, in the high-risk glaucoma group, intravitreal injection of an anti-VEGF agent should be administered with IOP monitoring and managed in case of IOP elevation.”
Limitations of the study included the retrospective design and lack of a strict protocol for visual acuity assessment, the authors said. – by Matt Hasson