Switching Anti-Vascular Endothelial Growth Factors in Refractory Neovascular Age-Related Macular Degeneration

Ashraf, Mohammed FRCOphth
Banaee, Touka MD
Silva, Fabiana Q.
Singh, Rishi P. MD

From the Ophthalmology Department, Alexandria Faculty of Medicine, Alexandria, Egypt (MA); Ophthalmic Research Center and Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran (TB); and Cleveland Clinic Cole Eye Institute, Cleveland (TB, FOS, RPS).

Dr. Singh reports grants and personal fees from Regeneron, Genentech, and Novartis; and personal fees from Optos and Zeiss. The remaining authors report no relevant financial disclosures.

Dr. Singh did not participate in the editorial review of this manuscript.

Support for this study was provided by an unrestricted grant from Research to Prevent Blindness. The sponsor did not participate in the design, execution, data review, or publishing of this manuscript.

Address correspondence to Rishi P. Singh, MD, 9500 Euclid Avenue, Desk i32, Cleveland, OH 44195; email: [email protected].

Received May 08, 2017

Accepted August 03, 2017

Ophthalmic Surgery, Lasers, and Imaging Retina 49(3):p 166-170, March 01, 2018. | DOI: 10.3928/23258160-20180221-03

BACKGROUND AND OBJECTIVE:

Anti-vascular endothelial growth factor (VEGF) therapy is the treatment of choice for cases with neovascular age-related macular degeneration (AMD). Switching to an alternate anti-VEGF has been suggested as a possible option for resistant cases. The purpose of this review is to evaluate whether the timing of switching affects treatment outcomes.

PATIENTS AND METHODS:

A review of published literature was performed looking at all studies where patients with refractory neovascular AMD were switched to an alternative anti-VEGF. Studies were then stratified based on the timing of switching into early (< 12 previous injections) and late (> 12 previous injections).

RESULTS:

A total of 38 studies were identified: 18 where patients were switched early and 20 where they were switched late. Both subgroups showed anatomic improvement after switching, with limited visual gains.

CONCLUSION:

There are insufficient data to recommend early versus late switching. However, both groups showed a reduction of fluid on optical coherence tomography and visual gains in 25% to 30% of patients.

[Ophthalmic Surg Lasers Imaging Retina. 2018;49:166–170.]