Short-Term Outcomes of Switching to Ranibizumab Therapy for Diabetic Macular Edema in Patients with Persistent Fluid After Bevacizumab Therapy.

Abstract

To evaluate the efficacy of switching from bevacizumab to ranibizumab in patients with diabetic macular edema (DME). Patients with DME who showed persistent fluid after at least 3 monthly bevacizumab injections were administered a single ranibizumab injection and were followed up after 1 month. Anatomic responders to ranibizumab were followed up monthly and administered ranibizumab injections on an as-needed basis for 3 months. At the 1-month follow-up, mean central subfield foveal thickness (CSFT) decreased from 422 to 346 μm (P < 0.001) and mean best-corrected visual acuity (BCVA) improved from 20/49 to 20/46 (P = 0.063) in 62 enrolled eyes. Thirty-nine eyes (62.9%) were classified as anatomical responders and, after repeated ranibizumab injections (mean number: 2.6), mean CSFT improved (429-317 μm, P < 0.001) while BCVA was stabilized (20/52 to 20/48, P = 0.066) after 3 months, compared with baseline. The rate of patients who showed partial response to previous bevacizumab between anatomical responders and nonresponders to ranibizumab was compared. The results showed that the rate was significantly higher in the responder group than nonresponder group (76.9% vs. 43.5%, P = 0.008). Switching patients to ranibizumab may present a suitable option for the treatment of DME with persistent fluid after repeated bevacizumab injections. This treatment switch was more effective in eyes that showed partial response to previous bevacizumab therapy, compared with nonresponsive eyes.