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Neovascular AMD refractory to bevacizumab responds to ranibizumab

Session Details

Session Title: Quick Fire Free Paper Session 01

Session Date/Time: Thursday 26/09/2013 | 08:30-10:30

Paper Time: 09:05

Venue: Hall G1 (Level 2)

First Author: J.Pinheiro-Costa PORTUGAL

Co Author(s):    P. Freitas-da-Costa   M. Falc   F. Falc?o-Reis   A. Carneiro     

Abstract Details


To report a series of cases of patients with neovascular age-related macular degeneration (AMD) refractory to treatment with intravitreal bevacizumab that were successfully treated with intravitreal ranibizumab.


Department of Ophthalmology, Hospital de São João


Retrospective, observational case series. We report the outcomes of seventeen eyes refractory to treatment with bevacizumab that responded to treatment with ranibizumab. All reported patients were on treatment with an 1+PRN regimen, with evidence of initial decreased exudation followed by lack of response and increase in exudation. Signs of exudation included subreitnal fluid and/or intraretinal fluid. “Refractory to treatment” was defined as cases with persistent exudation after 3 or more consecutive monthly bevacizumab injections regardless of best-corrected visual acuity.


Seventeen eyes of 16 patients with neovascular AMD with a poor anatomic response to intravitreal bevacizumab were switched to intravitreal ranibizumab. Persistent subretinal fluid was present in 5 cases and persistent intraretinal fluid was present in 12 cases. None of the cases revealed polypoidal choroidal vasculopathy lesions on indocyanine green angiography during the follow-up. Mean time on bevacizumab was 13,3 ±5,4 months, followed by 8,1 ±4,3 months on ranibizumab. With the switch to ranibizumab all patients showed anatomic improvement with fluid reduction in or under the retina. Complete resolution of fluid on OCT was achieved in 8 cases and central retinal thickness showed a significant decrease of 161.0 (±158.7) μm (P=0.001). The mean BCVA variation did not follow the structural improvement, and VA remained stable within a range of ±5 letters in almost all patients. With the switch there was a non significant decrease from 62.4 to 60.5 letters (P=0.358).


Patients with neovascular AMD that maintain evidence of subretinal or intraretinal fluid despite consecutive treatment with bevacizumab, may show significant anatomical improvement when treatment is switched to ranibizumab. The majority of cases in this series demonstrated good response after the switch. This may be due to tachyphylaxis or pharmacokinet tolerance.

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