To evaluate the anatomical and visual outcomes in age related macular degeneration patients who switched from intravitreal ranibizumab to aflibercept

Purpose: The aim of this study was to evaluate the anatomical and visual outcomes of intravitreal aflibercept treatment in patients with age-related age-related macular degeneration (AMD) who can not receive sufficient visual and anatomical response to prior intravitreal ranibizumab treatment. Materials and methods: Fourty eyes of 37 patients were analyzed. This is a retrospective review of eyes with neovascular AMD switched to intravitreal aflibercept from ranibizumab protocol, with at least 6 months of follow-up after the switch. All patients had been treated with intravitreal ranibizumab for at least 12 months before the switch. This study measured the visual outcome (best corrected visual acuity (BCVA); logMAR), as follows: before switching, after switching from ranibizumab to aflibercept treatment (final follow-up). SD-OCT evaluated foveal morphology (photoreceptor inner/outer segment junction (ISOS) , external limiting membrane (ELM), intra- and subretinal fluid (IRF, SRF), maximum PED height and PED basal diameter) and central macular thickness. Results: A total of 40 eyes of 37 patients (20 females, 17 males) were included. The mean age was 71.6 years (±9.1) (54-91) . Average number of injections at 6 months before switched was 2.34 (±1.01) injections and reduced to 1.91 (±0.7) injections after switch (p<0.05). While pre-switched best corrected visual acuity (BCVA) average of eyes was 0.50 (± 0.27) logMAR, reduced to 0.41 (± 0.30) logMAR and mean CMT decreased from 479.3 (±187) µm to 305.4 (±164.7) µm after switch (p<0.005). Mean maximum PED height and PED basal diameter before switched to aflibercept was 283 (±162) μm and 2972 (±1392) µm; reduced to a mean of 242 (±201) μm and 2927 (±1386) µm after switch(P> 0.05, respectively). Pre-switched to aflibercept, 22 eyes (%55) had intraretinal fluid and 31 eyes (%77.5) had subretinal fluid. At final visit after switch to aflibercept, 11 eyes (%27.5) had intraretinal fluid and 7 eyes (%17.5) had subretinal fluid. We found that the presence of intact ELM correlated significantly with the visual acuity. Conclusion: In patients with neovascular AMD, who had initially exhibited an inadequate response to ranibizumab, switching therapy to aflibercept improves clinical outcome measures. Besides morphological improvements, such as the decrease of the CRT and the axial height of PEDs, the average injection interval was prolonged. In addition, there was also statistically significant difference in the mean change of visual acuity Keywords: Neovascular age related macular degeneration, switch to intravitreal aflibercept from intravitreal ranibizumab, visual and anatomic outcomes