Abstract
BackgroundNeovascular age-related macular degeneration often requires chronic therapy with anti-VEGF agents, and patients with recurrent disease are challenging to manage.MethodsThis retrospective case series evaluates patients who were switched from bevacizumab or ranibizumab to aflibercept and then back again because of recurrent fluid on optical coherence tomography (OCT) by reporting changes in OCT measurements over the course of medication changes.ResultsTwenty-one eyes in nineteen patients received an average of 20.7 bevacizumab and/or ranibizumab injections and then an average of 7.2 aflibercept injections before being switched back to bevacizumab or ranibizumab because of recurrent fluid on OCT. Median central macular thickness improved on transition from bevacizumab or ranibizumab (317 μm) to aflibercept (285 μm; p = 0.034), then worsened over the course of aflibercept treatment (296 μm; p = 0.080), but improved again with transition from aflibercept back to bevacizumab or ranibizumab (283 μm; p = 0.016). The total volume of subretinal fluid, intraretinal fluid, and pigment epithelial detachments also decreased on transition from bevacizumab or ranibizumab (2.56 mm3) to aflibercept (2.44 mm3; p = 0.080), then worsened over the course of aflibercept treatment (3.18 mm3; p = 0.019), and improved again on transition back to bevacizumab or ranibizumab (2.11 mm3; p = 0.016).ConclusionsWhile aflibercept appears initially effective, some patients develop recurrent fluid with aflibercept that improves with transition back to bevacizumab or ranibizumab. Rotating anti-VEGF agents may be beneficial with recurrent neovascular activity.
Highlights
Neovascular age-related macular degeneration often requires chronic therapy with anti-vascular endothelial growth factor (VEGF) agents, and patients with recurrent disease are challenging to manage
At UCSF, 80 eyes with neovascular agerelated macular degeneration (AMD) were transitioned from bevacizumab or ranibizumab to aflibercept
Patients were transitioned from aflibercept to ranibizumab after a single injection because of immediate worsening on optical coherence tomography (OCT) or patient preference given immediate worsening of visual acuity (VA)
Summary
Neovascular age-related macular degeneration often requires chronic therapy with anti-VEGF agents, and patients with recurrent disease are challenging to manage. Intravitreal anti-vascular endothelial growth factor (VEGF) medications bevacizumab and ranibizumab are recognized for improving visual outcomes and decreasing macular fluid in patients with neovascular agerelated macular degeneration (AMD) [1, 2]. Over time, decreased responsiveness to these medications has been. Slean et al Int J Retin Vitr (2016) 2:2 aflibercept after having been treated with ranibizumab or bevacizumab but subsequently developed recurrences of fluid, and were switched back to either ranibizumab or bevacizumab
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