Abstract
Purpose :
When patients with macular edema due to pathologies like neovascular age-related macular degeneration (nAMD) and diabetic retinopathy (DR) fail to show significant improvement within the first 3 to 6 months of initiating anti vascular endothelial growth factor (anti-VEGF) treatment, they are often switched to a different anti-VEGF agent. However, the benefits of such a switch were not well established. We examined the effectiveness of anti-VEGF agent switching in eyes with retinal pathologies that show poor response to Bevacizumab Intra-vitreal injections.
Methods :
We retrospectively compared the results of the central macular thickness (CMT) and visual acuity (VA) between eyes with sub-optimal response to at least three Bevacizumab injections that continued retreatment with Bevacizumab versus those that switched to Aflibercept or Ranibizumab injections. 59 eyes were investigated: 21 eyes with Diabetic retinopathy (DR)- group A, 28 eyes with neovascular age-related macular degeneration (nAMD)- group B. Group C composed of group A and group B and 10 more eyes with either retinal vein occlusion or pseudophakic cystoid macular edema. Groups were divided into subgroups- groups A1 (8 eyes), B1(14 eyes), and C1 (25 eyes) continued to be treated with Bevacizumab. Groups A2, B2, C2 consisted of patients that switched to aflibercept or Ranibizumab injections and included 13, 14, and 34 eyes respectively.
Results :
In all eyes where treatment has been switched to either Aflibercept or Ranibizumab, a decrease of CMT was seen; 38.5 (SD 46.2); 92.6 (SD 106.8), and 82.1 (SD 115.6) microns in groups A2, B2, and C2 respectively. However,a mean increase of 1.63 microns (SD 87.3) was found in the CMT of eyes in group A1; and a mean decrease in CMT of 5.71 (SD 111.7) and 2.12 (SD 94.9) microns was found in group B1 and C1 respectively. The difference in CMT was statistically significance between groups B1 versus B2 and between C1 versus C2 groups (p=0.025, p=0.004, respectively). A similar trend was seen between groups A1 versus A2 but statistical significance was not achieved. Analysis of the visual acuity revealed no significant difference between all groups.
Conclusions :
Our results may indicate that switching between anti-VEGF agents is indeed an effective strategy to treat eyes with sub-optimal response to Bevacizumab injections.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.