Real-World Results of Switching Treatment from Ranibizumab to Aflibercept in Macular Oedema Secondary to Branch Retinal Vein Occlusion.

INTRODUCTION

To investigate treatment outcomes after switching from ranibizumab to aflibercept intravitreal injections in patients with macular oedema (MO) secondary to branch retinal vein occlusion (BRVO).

METHODS

Eligible patients with refractory MO secondary to BRVO, post treatment with a minimum of three intravitreal injections of ranibizumab at 4-weekly intervals were recruited. Suboptimal or non-responders were defined as patients who had persistent intraretinal fluid (< 75% decrease from baseline) despite a minimum of three consecutive injections. These patients were switched to aflibercept injections on an as-needed basis. The primary study outcomes assessed trends in best-corrected distance visual acuity (BCVA) and central retinal thickness (CRT). To compare means of BCVA and CRT, a paired t test two-tailed with a level of significance set at 0.05 was used. Pearson correlation coefficient was also applied to demonstrate correlation. Participants were followed up for a period of 24 weeks after switching.

RESULTS

Thirty-eight eyes of 38 patients were included in the study. Patients had an average of 8.37 ranibizumab intravitreal injections over a mean period of 12 months presenting suboptimal or no response. A significant decrease of mean CRT from 388.63 ± 93.4 μm to 290.29 ± 93.5 μm (p < 0.001) and an improvement in mean BCVA from logMAR 0.66 ± 0.38 to logMAR 0.57 ± 0.27 (p = 0.025) was achieved after an average of 2.27 aflibercept injections.

CONCLUSIONS

Given the spectrum of therapies available to date for the management of MO secondary to BRVO, aflibercept appears to be an effective treatment option in cases refractory to ranibizumab. This study based on a small cohort of patients indicates that satisfactory results on retinal anatomy and visual outcomes can be accomplished with a smaller number of injections. Larger-scale studies are needed to extrapolate these promising results.