Comparison of responses to ranibizumab and aflibercept injections in patients unresponsive to intravitreal bevacizumab in age-related macular degeneration

INTRODUCTION AND PURPOSE Comparison of responses to ranibizumab (RA) and aflibercept (AF) injections with best corrected visual acuity (BCVA) and optical coherence tomography (OCT) parameters; central foveal thickness (CFT), subretinal fluid (SRF) and pigment epithelial detachment (PED) size in age-related macular degeneration patients unresponsive to intravitreal bevacizumab. METHOD In this retrospective study, patients who were diagnosed with wet AMD with CNVM secondary to AMD in FFA and followed up for 2 years in Akdeniz University Hospital Ophthalmology Clinic between 2019 and 2022 and who received intravitreal injection therapy were included. Patients who were administered 3 consecutive doses of bevacizumab at 4-6 week intervals and who did not respond were administered 3 consecutive doses of intravitreal RA or AF at 4-6 week intervals. Patients with inadequate response were followed up with additional doses according to the treat and extend regimen. FINDINGS The study included 47 M , 42 F , 89 patients (6 bilateral) 95 eyes in AF group and 82 M , 38 F , 120 patients (11 bilateral) 131 eyes in RA group. 226 eyes of 209 patients were included in the study. All patients underwent dilated fundus examination at 0, 3, 6, 12, 18 and 24 months, OCT parameters (SFK, SRS, PED) and BCVA were evaluated. Comparison was made between both groups from baseline to 24th month. There was no significant (p>0.05) difference between RA and AF groups in BCVA, CFT, and SRF change at 3.month/24.month. PED decrease at 3.month/24.month in RA group was significantly (p<0.05) higher than AF group. Total number of injections was significantly (p<0.05) higher in the RA group than in the AF group. DISCUSSION AND CONCLUSION It was found that intravitreal AF and RA injections produced similar results on OCT findings other than PED and BCVA in wet AMD patients. Although the vertical PED size reduction was higher in the RA group than in the AF group, it was concluded that the total number of injections was higher in the RA group during the 24-month follow-up period. Keywords:Age-related macular degeneration , Visual acuity , Optical coherence tomography , aflibercept , ranibizumab