Effects of switching back from aflibercept to ranibizumab in eyes with neovascular age-related macular degeneration and initial therapy with ranibizumab

Session Details

Session Title: Free Paper Session 9: AMD III

Session Date/Time: Friday 08/09/2017 | 08:00-09:30

Paper Time: 08:42

Venue: Room 117

First Author: : J.Wons SWITZERLAND

Co Author(s): :    D. Gelen   M. Becker   S. Michels                       

Abstract Details


Evaluation of functional and anatomic parameters in patients with neovascular age-related macular degeneration (nAMD) switched back to ranibizumab after aflibercept treatment.


This retrospective single centre, non-randomized study was performed at the City Hospital Triemli, Zurich (Switzerland).


Patients who did not respond with a reduction of the retinal thickness due to persistent intraretinal or subretinal fluid under ‘treat and extend’ regime were switched after the intravitreal anti-VEGF therapy start with ranibizumab to aflibercept. After several injections a second switch to the previous anti-VEGF agent ranibizumab was performed due to insufficient response. In this study 50 patients were retrospectively examined over a period of at least six months after back switch investigating the effects of the second drug change under ‘treat and extend’ conditions on BCVA, retinal thickness, interval of injections and number of total injections. The data from the first and second switch were compared. The retinal thickness was measured with the spectral domain optical coherence tomography (SD-OCT) using Spectralis system (Heidelberg Engineering, Heidelberg, Germany) in follow-up mode. The statistical analysis was performed with SPSS.


In 65% of the back switch patients a therapy response with a reduction of the retinal thickness of minimum 10µm (range 10-152µm) one month after back switch could be measured. No significant prolongation of the injection interval after back switch could be detected. There was no significant change in the BCVA. After a follow up of 6 months half of the patients continued on a ‘treat and extend’ therapy with ranibizumab, the other half was switched back again to aflibercept due to insufficient response.


A drug change of anti-VEGF therapy in nAMD is required in a high number of patients with insufficient response. In this group of 50 patients with nAMD under ‘treat and extend’ a back switch to ranibizumab could lead to a reduction of the retinal thickness after the first injection in two-thirds of the patients. A benefit of switching back to the primary anti-VEGF agent ranibizumab in terms of prolongation of injection interval and BCVA improvement could not be detected in our patient group after six months.

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