Comparison of subretinal aflibercept vs ranibizumab vs bevacizumab in the context of PPV, pneumatic displacement with subretinal air and subretinal tPA in naïve submacular haemorrhage secondary to nAMD. “The Submarine Study”

Jul 27, 2023

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To compare efficacy and safety profile of subretinal aflibercept, ranibizumab, and bevacizumab in the context of pars plana vitrectomy, pneumatic displacement with subretinal air and subretinal tPA for subretinal macular haemorrhage (SMH) due to naïve neovascular age-related macular degeneration (nAMD).

Retrospective interventional cohort study.

123 eyes of 123 patients treated with subretinal aflibercept (n = 41, 33%), ranibizumab (n = 41,33%), and bevacizumab (n = 41, 33%).

Review of electronic medical records for best corrected visual acuity (BCVA), central subfoveal thickness (CST), and intraocular pressure (IOP) at baseline and 24 months after treatment.

BCVA, CST, and number of intravitreal anti VEGF over 24 months.

Mean age of patients was 80.5 ± 5.5 years, 43.9% were female. Mean time from symptom onset until surgery was 1.1 days (range 0–3 days). In all cases, the SMH did not reach the arcades. CST at baseline was 627 ± 140 µ, 739 ± 54 µ, and 793 ± 93 µ (p = 0.0001) for aflibercept, ranibizumab, or bevacizumab, respectively. Baseline BCVA (logMAR) was 0.65 ± 0.13, 0.69 ± 0.96, and 0.74 ± 0.81 (p = 0.0041) for aflibercept, ranibizumab, and bevacizumab, respectively. All three groups showed statistically significant improvement in BCVA and CST (for all groups: p < 0.001). There was no statistically significant difference at the final BCVA (p = 0.789). The mean number of anti VEGF given during follow-up period was 5.2 ± 0.81, 4.4 ± 0.63, and 5.5 ± 0.95 (p = 0.0001) for aflibercept, ranibizumab, and bevacizumab, respectively.

This study shows that aflibercept, ranibizumab, and bevacizumab in a subretinal manner in the context of PPV, pneumatic displacement with subretinal air and subretinal tPA for subretinal macular haemorrhage secondary to naïve nAMD work with the same efficacy and safety profile.

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Anat Loewenstein and Dinah Zur, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

Private Retina Office, University of Buenos Aires, Buenos Aires, Argentina

Matias Iglicki

Medical Investigation Institute “Alfredo Lanari”, University of Buenos Aires, Buenos Aires, Argentina

Marina Khoury & Javier Ignacio Melamud

Ophthalmologic Institute, Buenos Aires, Argentina

Lucas Donato

Diagnostic Ophthalmology Center, Buenos Aires, Argentina

Diego Jose Quispe & Hermino Pablo Negri

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MI, DJQ, MK. - Substantial contributions to the conception or design of the work; the acquisition, analysis, and interpretation of data for the work. - Drafting the work or revising it critically for important intellectual content. - Final approval of the version to be published. - Ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. JIM, LD, HPN - Substantial contributions to the conception or design of the work and interpretation of data for the work. - Drafting the work or revising it critically for important intellectual content. - Final approval of the version to be published. - Ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Correspondence to Matias Iglicki.

All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: no support from any organization for the submit- ted work; no financial relationships with any organizations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

As this was a retrospective study, participants' informed consent was not needed, in compliance with the Institutional review board (IRB) approval. This study protocol was reviewed and approved by the local IRB. The research adhered to the tenets of the Declaration of Helsinki.

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Iglicki, M., Khoury, M., Donato, L. et al. Comparison of subretinal aflibercept vs ranibizumab vs bevacizumab in the context of PPV, pneumatic displacement with subretinal air and subretinal tPA in naïve submacular haemorrhage secondary to nAMD. “The Submarine Study”. Eye (2023). https://doi.org/10.1038/s41433-023-02676-9

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Received: 31 December 2022

Revised: 29 June 2023

Accepted: 17 July 2023

Published: 03 August 2023

DOI: https://doi.org/10.1038/s41433-023-02676-9

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