Type 3 CNV and anti-VEGF
Reviewed by Saruban Pasu

The purpose of the study was to determine the differences between aflibercept and ranibizumab in terms of their therapeutic efficacy in the treatment of Type 3 neovascularisation. The authors highlight that the dominant mechanism for Type 3 neovascularisation development is still uncertain and controversial. All patients were loaded with three monthly injections, with follow-on treatment on a pro re nata (PRN) regimen. Ranibizumab was given at monthly intervals, with aflibercept given at two monthly intervals. A total of 63 eyes with treatment naïve Type 3 CNV were included in this retrospective study. At baseline, there were no significant differences between the aflibercept-treated eyes (21 eyes) and ranibizumab-treated eyes (42 eyes) in terms of BCVA, central foveal thickness, lesion location, mean lesion size, presence of PED, presence of reticular pseudodrusen, or subfoveal choroidal thickness (Table 1). The mean number of injections also did not significantly differ between the groups (4.53±1.33 in the aflibercept-treated group and 4.87±1.55 in the ranibizumab-treated group; P=0.213). In total, all subjects (63 eyes) received a mean of 4.76±1.61 intravitreal injections during the 12 month study period (range: 3-10). The mean BCVA (logarithm of the minimum angle of resolution [Snellen equivalent]) of the aflibercept-treated group improved from 0.71±0.42 (20/102) to 0.54±0.39 (20/69) after 12 months (P=0.022). The BCVA of the ranibizumab-treated groups also improved similarly from 0.68±0.38 (20/95) to 0.53±0.36 (20/67) after 12 months of treatment (P=0.013). However, no significant difference was found between the drugs regarding BCVA improvement. Among all subjects, GA developed in 17 eyes (27.0%) during the 12 month follow-up. the incidence of GA development was significantly higher in The aflibercept-treated group than in the ranibizumab-treated group (P=0.045); nine eyes (42.9%) developed GA in the aflibercept-treated group, and eight eyes (19.0%) developed GA in the ranibizumab-treated group.

Intravitreal aflibercept and ranibizumab injections for Type 3 neovascularization.
Cho HJ, Hwang HJ, Kim HS, et al.
RETINA
2018;38(11):2150-8.