Treatment outcome of switching from ranibizumab to aflibercept in patients with central retinal vein occlusion

PurposeTo describe the outcome of switching from ranibizumab to aflibercept intravitreal injections in patients with macular oedema secondary to central retinal vein occlusion (CRVO).MethodsA prospective observational study was conducted in a tertiary retina service in East Midlands, UK. Twenty one patients with CRVO and associated macular oedema were reviewed. All patients had a detailed systemic and ocular history obtained and a thorough ocular examination including visual acuity assessment, intraocular pressure measurement and dilated fundus examination. Best‐corrected visual acuity (BCVA) and central retinal thickness (CRT) were recorded at the initial and all following visits. Non‐responders were defined as patients who despite a minimum of 3 consecutive ranibizumab injections at 4–6 weeks intervals had persistent intraretinal fluid 1 month after the last injection. These patients were switched to aflibercept. BCVA and CRT were measured before and after switching.ResultsTwenty‐two eyes of 21 patients with refractory macular oedema secondary to CRVO were included. All eyes had a mean 4.5 ranibizumab intravitreal injections after a mean period of 6 months without reduction of intraretinal fluid and/or no visual acuity gain. In these cases, a treatment change to aflibercept injections on a per‐needed basis was decided. A significant decrease of mean CRT from 631 to 285 μm and improvement in mean BCVA from 1.3 logMAR to 1.0 logMAR was noticed. The mean number of aflibercept injections needed for oedema resolution was 2.ConclusionsAflibercept is an efficient alternative treatment for macular oedema secondary to CRVO refractory to ranibizumab. Good anatomic and functional result can be achieved with few injections. The maintenance of these results after 6 months is yet to be investigated.