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Comparison of anti-VEGF therapies on fibrovascular pigment epithelial detachments in age-related macular degeneration
  1. Adrian Au1,
  2. Vishal S Parikh2,
  3. Rishi P Singh2,
  4. Justis P Ehlers2,
  5. Alex Yuan2,
  6. Aleksandra V Rachitskaya2,
  7. Jonathan E Sears2,
  8. Sunil K Srivastava2,
  9. Peter K Kaiser2,
  10. Andrew P Schachat2,
  11. Daniel F Martin2,
  12. Yasha Modi2
  1. 1Case Western Reserve School of Medicine, Cleveland, Ohio, USA
  2. 2Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
  1. Correspondence to Dr Yasha Modi, 721 5th Avenue, Apt 37F, New York, NY 10022, USA; yasha.modi{at}


Background The aim is to compare the therapeutic effects of three antivascular endothelial growth factor (VEGF) drugs (bevacizumab, aflibercept and ranibizumab) on fibrovascular pigment epithelial detachments (fvPEDs) in age-related macular degeneration (AMD).

Methods This was a retrospective, comparative, consecutive case series of 88 unique eyes with fvPEDs in neovascular AMD treated with anti-VEGF monotherapy for a minimum of 6 months. All eyes were treatment naive. Diagnosis was confirmed retrospectively by fluorescein angiography and spectral-domain optical coherence tomography. Exclusion criteria included serous/drusenoid PEDs or patients who switched anti-VEGF. Mean follow-up across all therapies was 313.9±85.3 days.

Results Average age of all patients was 80.6 years. Baseline maximum subfoveal PED height was 326.8±185.1 μm, 394.5±238.6 μm and 258.0±145.3 μm for bevacizumab, aflibercept and ranibizumab, respectively (p=0.05). All patients had subretinal fluid, intraretinal fluid or a combination of the two at an initial presentation. Central retinal thickness decreased at all time points compared with baseline across all three anti-VEGF therapies. Subfoveal PED height decreased in patients treated with aflibercept at all time points and decreased in patients treated with bevacizumab at 1-month, 3-month and 6-month time points. Aflibercept reduced PED height more than bevacizumab at 1-month and 12-month follow-ups (p=0.02 and p=0.03, respectively) and ranibizumab at 1-month and 6-month follow-ups (p=0.03 and p=0.02, respectively). No differences in best-corrected visual acuity were appreciated at any time point between drugs.

Conclusions There was a significant reduction in subfoveal PED height for aflibercept and bevacizumab compared with baseline. A direct comparison of drugs demonstrated a beneficial reduction of PED height, albeit inconsistently, favouring aflibercept. There were no differences in visual acuity across the groups at any time point.

  • Retina
  • Pathology
  • Neovascularisation
  • Drugs

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  • Contributors AA and YM designed and conducted the study; AA and YM managed, analysed and interpreted the data; AA, VSP, RPS, JPE, APS and YM prepared, reviewed and approved the manuscript; JPE, AY, AVR, JES, SKS, PKK, APS, DFM and RPS provided patients; and YM, AA, VSP, JPE, APS and RPS decided to submit the manuscript for publication.

  • Funding Support was graciously provided by Carl Zeiss Meditec.

  • Competing interests RPS: Regeneron (FS, C), Thrombogenics (FS, C), Alcon (FS, C) and Genentech (FS, C). AVR: Allergan (C). JPE: Bioptigen (C), Thrombogenics (R, C), Zeiss (C), Alcon (C) and Leica (C). SKS: Regeneron (C), Bausch and Lomb (C, FS), Clearside (C, FS), Novartis (FS), Allergan (FS), Carl Zeiss Meditec (C) and Santen (C). PKK: Genentech (R, C), Novartis (R, C), Regeneron (R, C), Bayer HealthCare Pharmaceuticals (C) and Kanghong Biotechnology (C). APS: Allergan (C), Bausch and Lomb (C), AnGes (C) and Elsevier (R).

  • Ethics approval Institutional Review Board at the Cleveland Clinic.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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