Delhi Journal of Ophthalmology

Clinical Response To Switch From Ranibizumab To Aflibercept In Wet Age-Related Macular Degeneration

Bhagya Weerasinghe,1 Chandni Gupta,2 Yasmin Levene,3 Jai Shankar1
1Department of Ophthalmology, Wrexham Maelor Hospital, Betsi Cadwaladr University Health Board, Croesnewydd, Road, Wrexham, United Kingdom
2Department of Ophthalmology, Moorfields Eye Hospital, London, United Kingdom
3Department of Histopathology, Royal Free Hospital, Pond St, Hampstead, London, United Kingdom

Editor-in-Chief, Delhi Journal of Ophthalmology, Dr R.P.Centre, AIIMS.


Corresponding Author:

Jai Shankar
Consultant Ophthalmologist
Department of Ophthalmology
Wrexham Maelor Hospital, Betsi Cadwaladr University Health Board,Croesnewydd Road
Wrexham, LL13 7TD, United Kingdom
Email: shobitha_jai@yahoo.co.uk


Received: 04-NOV-2020 Accepted: 03-DEC-2020 Published Online: 12-MAR-2021
DOI: https://dx.doi.org/10.7869/djo.625

Abstract
Introduction: To assess whether switching from Ranibizumab to Aflibercept conferred benefit in visual acuity (VA) and central macular thickness (CMT) in patients with wet age-related macular degeneration (AMD).

Methods: Mean change in VA and CMT was assessed in wet AMD patients 6 months prior and 6 months after switch from Ranibizumab to Aflibercept, between July 2014 and November 2016. 

Results: 90 eyes were switched from Ranibizumab to Aflibercept. VA improved in 11 eyes, 65 reported no change and 14 showed deterioration. Improvement in VA was not statistically significant (p>0.05). CMT improved in 24 eyes, 64 showed no change and in 2 there was deterioration. This improvement was statistically significant (p<0.01). Sub-analysis into patients that had switched to Aflibercept after 6 (28 patients) or >6 (62 patients) Ranibizumab injections showed no significant difference between these groups for VA or CMT change. 

Conclusion: Although there seemed to be an improvement in the CMT with Aflibercept, this did not translate as a statistical improvement in VA. Switching earlier to Aflibercept did not show any significant benefit in either VA or reduced CMT within the first 6 months. Our research however, requires extension as the benefits may be seen over a longer period of time. In conclusion, some patients with sub-optimal response to Ranibizumab may benefit from switching to Aflibercept.

Keywords :Wet Amd, Ranibizumab, Aflibercept, Switch, Outcome