Comparison of sub retinal aflibercept vs ranibizumab vs bevacizumab in the context of PPV, pneu ma tic displacement with sub r etinal air and subret in al tPA in naïve submacular haemorrha ge secondary to nAMD. “ The Submarine Study ”

Objective 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). Design Retrospective interventional cohort study. Participants 123 eyes of 123 patients treated with subretinal aflibercept ( n = 41, 33%), ranibizumab ( n = 41,33%), and bevacizumab ( n = 41, 33%). Methods 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. Main outcome measures BCVA, CST, and number of intravitreal anti VEGF over 24 months. Results 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. Conclusion 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.