Original article
A Prospective Randomized Trial of Intravitreal Bevacizumab Versus Ranibizumab for the Management of Diabetic Macular Edema

https://doi.org/10.1016/j.ajo.2013.04.026Get rights and content
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Purpose

To compare visual acuity and spectral-domain optical coherence tomography (SDOCT) outcomes associated with intravitreal (IV) bevacizumab vs IV ranibizumab for the management of diabetic macular edema (DME).

Design

Prospective randomized trial.

Methods

Forty-eight patients (63 eyes) with center-involved DME were randomly assigned to receive 1.5 mg (0.06 cc) IV bevacizumab or 0.5 mg (0.05 cc) IV ranibizumab at baseline and monthly if central subfield thickness was greater than 275 μm.

Results

Forty-five patients (60 eyes) completed 48 weeks of follow-up. At baseline, mean ± standard error best-corrected visual acuity (BCVA) (logMAR) was 0.60 (20/80) ± 0.05 in the IV bevacizumab group and 0.63 (20/85) ± 0.05 in the IV ranibizumab group. A significant improvement in mean BCVA was observed in both groups at all study visits (P < .05); this improvement was significantly greater in the IV ranibizumab group compared with the IV bevacizumab group at weeks 8 (P = .032) and 32 (P = .042). A significant reduction in mean central subfield thickness was observed in both groups at all study visits compared with baseline (P < .05), with no significant difference in the magnitude of macular thickness reduction between groups. The mean number of injections was significantly higher (P = .005) in the IV bevacizumab group (9.84) than in the IV ranibizumab group (7.67).

Conclusions

IV bevacizumab and IV ranibizumab are associated with similar effects on central subfield thickness in patients with DME through 1 year of follow-up. IV ranibizumab is associated with greater improvement in BCVA at some study visits, and the mean number of injections is higher in the IV bevacizumab group.

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Antonio Brunno Nepomuceno received his medical degree from the Federal University of Ceará, Fortaleza, Brazil. In 2011, he completed his ophthalmology residency and started working as a retinal fellowship trainning at the School of Medicine of Ribeirao Preto, University of São Paulo, Ribeirão Preto, Brazil. His primary research interests pertain to diabetic retinopathy, macular edema and anti-VEGF agents.

Rodrigo Jorge is an Associate Professor and coordinates the Postgraduate program in the Ophthalmology Department and in the Retina and Vitreous Division in Clinics Hospital, School of Medicine of Ribeirão Preto, University of São Paulo. He has taught and published in the field of vitreoretinal diseases, with over 80 publications. Since 2006, his research has focused on anti-VEGF therapy studies and his collaborative study group has published the most cited prospective studies of age-related macular degeneration and diabetic retinopathy conceived and conducted in Brazil.