Purpose
To identify patients being switched from aflibercept back to ranibizumab/bevacizumab and evaluate the sociodemographic factors, medical history, visual acuity, and optical coherence tomography (OCT) changes present in these patients.
Methods
Retrospective review at UCSF of WAMD patients’ intravitreal treatment. Outcome variables included visual acuity, manually measured central macular thickness (CMT) on OCT, and simplified volumetric grading of pigment epithelial detachments (PED), subretinal fluid (SRF), and intraretinal fluid (IRF) on OCT before and after medication changes.
Results
69 eyes with WAMD were transitioned to aflibercept from ranibizumab/bevacizumab. Of these, only 14 eyes in 13 patients were transitioned back to ranibizumab after 4.64 aflibercept injections (range 1-10). In 9 cases (64.3%), patients were switched back because of providers’ concerns over persistent or new exudation. Mean CMT improved from 425.5 µm on ranibizumab to 390.21 µm on aflibercept (p=0.44), then increased to 402.57 (p=0.47) during aflibercept treatment, and improved to 384.46 (p=0.35) with the transition to ranibizumab. Total volume of SRF, IRF, and PED decreased from 2.4 x 109 µm3 on ranibizumab to 1.8 x 109 µm3 on aflibercept (p=0.16), then increased during aflibercept treatment (2.1 x 109, p=0.22), and decreased upon initial switch back to ranibizumab (1.6 x 109, p=0.12). IRF and PED decreased after switching from ranibizumab to aflibercept (1.2 x 109 to 8 x 108 µm3, p=0.20; 8.2 x 108 to 6.2 x 108 µm3, p=0.18). IRF and PED also increased during aflibercept treatment (9.5 x 108, p=0.08; 7.5 x 108, p=0.37). Upon switching from aflibercept back to ranibizumab, SRF and PED decreased (1.8 x 108, p=0.26; 4 x 108, p=0.18). Visual acuity showed little change with medication change from ranibizumab to aflibercept (logMAR 0.54, p=0.87), during aflibercept treatment (0.66, p=0.21), or transition back to ranibizumab (0.68, p=0.93).
Conclusions
Select patients demonstrate persistent or new exudation while on aflibercept. CMT and total volume of SRF, IRF, and PED showed an initial improvement on switch to aflibercept from ranibizumab, but this change diminished over time. CMT and total volume also showed improvement on initial switch back to ranibizumab. Due to the small sample size, results were not statistically significant.