Results of Re-switch from Intravitreal Aflibercept to Ranibizumab in Patients with Exudative Age-related Macular Degeneration

Background The purpose of this study was to investigate the effectiveness of re-switch from intravitreal aflibercept to ranibizumab in patients with exudative age-related macular degeneration. Materials and Methods This retrospective case series included 17 eyes of 17 patients who had previously switched from ranibizumab to aflibercept and finally back to ranibizumab. Main outcomes were change of visual acuity (VA) and assessment of central macular thickness (CMT). Secondary outcomes included predictive factors which had a beneficial effect as VA and CMT before re-switch, number of previous injections and gender. Results The mean VA was 0.64 +/- 0.36logMAR before the switch, and 0.87 +/- 0.40logMAR before the re-switch, and gained with a slight but not significantly improvement up to 0.85 +/- 0.58 logMAR after the re-switch (p = 0.896). The average CMT before the switch was 448.6 mu m +/- 181.5. This decreased to 343.8 mu m +/- 161.3 after the switch (p = 0.614) to 299.1 mu m +/- 155.8 at switchback (p = 0.133). Overall, 8 patients (47%) had an improvement of vision, whereas in 5 patients (30%) VA deteriorated. Further analysis of predictive factors revealed a mean improvement of VA in male patients after re-switch, while female patients lost VA, with statistical significance between after the switch and after the re-switch to the benefit of male patients (p = 0.016). Conclusions A re-switch from aflibercept to ranibizumab may enable improvement in morphological parameters and stabilization of VA in patients with exudative age-related macular degeneration who achieved no more benefit from the initial switch.