2MD, University of Health Sciences, Beyoglu Eye Training and Research Hospital, Department of Ophthalmology, Istanbul, Turkey
3MD, FEBO, FICO, Marmara University School of Medicine, Department of Ophthalmology, Istanbul, Turkey
4Prof. MD, FEBO, FICO, FICS, FACS, MRCSEd, Acibadem University School of Medicine Department of Ophthalmology Istanbul, Turkey DOI : 10.37845/ret.vit.2021.30.58 Purpose: In this study, it was aimed to evaluate the effi cacy of switching to intravitreal ranibizumab (IVR) in patients with neovascular age-related macular degeneration (nAMD) who were unresponsive or had suboptimal treatment response to intravitreal afl ibercept (IVA) therapy and to determine predictive factors for switch response.
Methods: Patients were divided into 2 subgroups according to treatment resistance. Group 1 included non-responders while group 2 included those with suboptimal treatment response. Then, the patients switched to another treatment (switch from IVA to IVR) in both groups. Loading dose with monthly IVR injection (0.5 mg) (3 dose) was administered for 3 months following the switch; followed by pro re nata (PRN) IVR protocol. Main outcome measures including best-corrected visual acuity (BCVA), intraretinal fl uid (IRF), subretinal fl uid (SRF), pigment epithelial detachment (PED), and central retinal thickness (CRT) were assessed at baseline (T1), at time of switch (T2) and 3 months (T3) and 6 months after switch (T4).
Results: We retrospective reviewed data regarding 40 eyes of from 36 patients with nAMD who were refractory to IVA treatment and switched to IVR. There was unresponsiveness in 2 eyes and suboptimal response in 38 eyes. A CRT increase was found from time point of T1 to T2 while a reduction was observed from T2 to T3 and T3 to T4 after switch. Regression analysis of alterations monthly demonstrated among time points showed signifi cant differences in PED height (p=0.02), CRT (p=0.01), SRF (p = 0.01), and IRF (p = 0.03). However, no signifi cant change was detected regarding BCVA (p>0.05). Predictive factors for good switch response criteria were worsening response between T1 and T2 time point, higher and thicker measurements at the T2 time point, male gender, shorter therapy before switch, and smaller number of previous injections at initial therapy.
Conclusion: Eyes with IVA-resistant nAMD which had anatomical and functional deteriorated prior to switch benefi ted from switch to IVR. Our fi ndings can facilitate appropriate therapy decisions and potentially improve anatomic and visual results.
Keywords : Afl ibercept, anti-VEGF, neovascular age-related macular degeneration ranibizumab, switch