Comparison of treatment outcomes of intravitreal ranibizumab with aflibercept in cases of treatment naive neovascular AGE related macular degeneration

Purpose: To compare the functional and morphological treatment outcomes of ranibizumab with aflibercept in cases of treatment naive neovascular age-related macular degeneration(AMD) in a real life clinical setting. Metods: This retrospective single-institution study included patients who had been diagnosed with treatment-naive neovascular AMD. The study included 30 eyes of 27 patients in aflibercept group,38 eyes of 32 patients in ranibizumab group. After a fixed loading dose of three injections, PRN treatment regimen was applied to all patients. Retreatment was allowed if anatomical or functional deterioration was noted at follow –up visits. Changes in visual acuity(letters) and central foveal thickness(CFT) ,the best corrected visual acuity(BCVA) at before after treatment as well as number of injections were compared between ranibizumab and aflibercept groups. Results: In the ranibizumab group, the mean BCVA value was 0,92±0,53 logMAR before treatment and 0,83±0,52 logMAR after treatment(p:0,123). In the aflibercept group, the mean BCVA value was 1,03±0,57 logMAR and 0,94±0,6 logMAR after treatment(p:0,061). In both groups, there was no significant difference in posttreatment BCVA compared with pretreatment visual acuity. BCVA either improved or visual loss ˂ 15 ETDRS letter in %86,7 of eyes, visual gain ≥ 15 ETDRS letter in % 23,3 of eyes and visual loss ≥ 15 ETDRS letter in %13,3 of eyes were noted in the aflibercept group. BCVA either improved or visual loss ˂ 15 ETDRS letter in %89,5 of eyes, visual gain ≥ 15 ETDRS letter in % 23,8 of eyes and visual loss ≥ 15 ETDRS letter in %15,8 of eyes were noted in the ranibizumab group. There was no difference for this proportional visual gains between two groups(p:0,956). The mean number of injections was 3,86 in both groups. The mean follow-up time was 9,4 months in the ranibizumab group,9,9 months in the aflibercept group. There was no significant difference in the mean number of injections and the mean follow-up time between two groups. Visual gain was 4,47±17,07 letter in the ranibizumab group and 4,00±12,27 letter in the aflibercept group. There was a significant decrease in CFT from the baseline values in both groups at the end of the follow up period.(p:0,000).No significant difference in visual gain(p:0,899), reduction of CFT(p:0,495) was observed between the two treatment groups. Also there were no significant difference in the intraoculer presurre during the follow up period in both groups. Conclusions: Although no significant difference was observed in both groups between posttreatment BCVA compared with pretreatment visual acuity, stabilization of visual acuity was observed in the majority of patients in both groups. The mean number of injections was similar and there was no significant difference in visual and anatomic changes between two groups. Both intravitreal ranibizumab and aflibercept therapy demonstrated similar efficacy in visual and anatomic changes with similar injection burden in treatment naive patients with neovascular AMD.