Author: Joana Fernandes (Portugal)
Co-authors: Filipe Neves, Ricardo Machado Soares, Catarina Cunha Ferreira, Eduardo Saraiva, Luís Silva, Lígia Ribeiro
Visual impairment in central (CRVO) or branch retinal vein occlusion (BRVO) is mostly caused by macular edema (ME). Numerous studies showed that intravitreal (IV) vascular endothelial-derived growth factor inhibitors (anti-VEGF) markedly improve anatomical and functional outcomes in the setting of retinal vein occlusions (RVO). When an insufficient response is observed after adequate therapy, switching to another anti-VEGF agent may be considered. This study aims to investigate the real world anatomical and functional outcomes after the anti-VEGF agent switch, from bevacizumab to ranibizumab, in patients with persistent ME secondary to CRVO or BRVO.
Department of Ophthalmology of Centro Hospitalar Vila Nova de Gaia/Espinho
Retrospective analysis of eyes with refractory ME secondary to CRVO or BRVO in which a therapeutic anti-VEGF switch from bevacizumab to ranibizumab was performed. Incluision criteria were: a) diagnosis of RVO with treatment resistance, b) a minimum of three consecutive IV injections of bevacizumab before the switch and c) three IV injections of ranibizumab after the switch. Treatment resistance was defined as central foveal thickness (CFT) reductions <100µm and/or CFT> 350µm after treatment and/or absence of anatomical improvement after initial treatment with bevacizumab. Primary outcomes were best corrected visual acuity (BCVA) and CFT after 3 ranibizumab injections.
Twenty-one eyes of 21 patients were included in the study: 13 BRVO and 8 CRVO. The median age was 74 (15) years. On average, the switch was performed 34.43 ± 3.47 months after diagnosis and after 9.57 ± 1.17 bevacizumab intravitreal injections. Before the switch, the mean BCVA was 0.65 ± 0.81 logMAR and the mean CFT was 507.10 ± 30.51µm. After three ranibizumab intravitreal injections, the mean BCVA improved 0.07 ± 0.05 logMAR (p = 0.171) and the mean CFT decreased 110.67 ± 29.83 µm (p = 0.001) compared to “pre-switch”. Subgroup analysis showed a significant decrease of mean CFT in both BRVO and CRVO (p=0,036 and p=0,015, respectively) after three injections of ranibizumab but no significant improvement was achieved in BCVA (p=0,082 and p=0,805, respectively). After 9.38 ± 1.15 injections of ranibizumab, the mean BCVA was 0.69 ± 0.13 logMAR (p = 0.324) and CFT was 353.48 ± 38.00 µm (p = 0.001). The duration of disease and the number of injections before the switch were not related to the BCVA or CFT after switch.
Our retrospective study showed that the switch to ranibizumab after suboptimal response to bevacizumab might lead to a significant anatomical improvement in eyes with macular edema due to RVO. However, visual function improvement was limited. Larger studies with early switch may validate and enhance our findings.