Comparison of anatomical and functional outcomes of Ranibizumab and Aflibercept treatment in patients with age-related macular degeneration resistant to bevacizumab: a one-year real life study

Author: Orhan Altunel (Turkey)

Co-authors:

Purpose

To compare the long term anatomical and functional outcomes of intravitreal ranibizumab versus aflibercept in patients with neovascular age-related macular degeneration resistant to bevacizumab.

Setting/Venue

Retrospective, cohort study, Kütahya Health Science University Hospital

Methods

This study included 63 eyes of 63 patients with nAMD resistant to bevacizumab treatment. In the case of residual intraretinal and subretinal fluid on optical coherence tomography image and/or no improvement visual acuity and/or no more than 100 μm central macular thickness decreases from baseline after a minimum of 4 monthly bevacizumab injections were defined as resistant to bevacizumab treatment. Patients who were switched from bevacizumab to ranibizumab or aflibercept were followed for 12 months. Data were obtained from medical records for retrospectively included patients. The treatment protocol included 3 monthly injections of ranibizumab or aflibercept as a loading phase after bevacizumab treatment and then treat and extent treatment. Primary outcome measures were mean changes in visual acuity, central retinal thickness and pigment epithelial detachment (PED) height at the end of the 12-month follow-up.

Results

Thirty two eyes of 32 patients were received ranibizumab injection, and 31 eyes of 31 patients received the aflibercept injection. Mean number of injections given at the end of the 12 months in aflibercept and ranibizumab groups were 7.6 and 7.8, respectively (p >0.05). Mean central retinal thickness decreased from 421.5 ± 154.8 to 231.4 ± 53.7 µm at 12 months in ranibizumab group (p < 0.001) and from 442.7 ± 152.3 to 224.6 ± 65.1 µm in the aflibercept group (p< 0.001). Also, PED height reduced from 182.4 ± 86.2 to 89.6 ± 32.8 µm in ranibizumab group (p < 0.001) and from 179.5 ± 83.1 to 51.7 ± 26.3 µm in the aflibercept group (p < 0.001). Mean PED height reduction was significantly higher in the aflibercept group (p < 0.05), whereas the changes in central retinal thickness was not statistically significant differences between groups (p>0.05). Visual acuity improved significantly at the 12 months in both groups (0.98 ± 0.35 to 0.62 ± 0.23 logMAR, p<0.001 in the ranibizumab group and 1.1 ± 0.41 to 0.69 ± 0.34 logMAR, p<0.001 in the aflibercept group). However, the increase in mean visual acuity favored the aflibercept group (p < 0.05).

Conlusions

The present study showed that the both of ranibizumab and aflibercept treatment were effective in eyes with nAMD resistant to bevacizumab therapy. However, anatomical and functional results were found to be better in the aflibercept treatment group compared with ranibizumab group in the long term follow-ups.

Financial Disclosure

no have financial relation