Intravitreal Bevacizumab Followed by Ranibizumab for Neovascular Age Related Macular Degeneratıon

Purpose: To compare the outcomes after switching from intravitreal bevacizumab (IVB) to intravitreal ranibizumab (IVR) in patients with neovascular age related macular degeneration (ARMD). Material and Methods: A retrospective review of patients with neovascular ARMD, who were switched from treatment with Pro Re Nata (PRN) IVB to PRN IVR, was conducted in a university clinic. IVB (1.25 mg/0.05 ml) and IVR (0.5 mg/0.05 ml) were used. Retreatment criteria were defined based on an activity scoring (AS) system developed in our clinic. An AS was calculated for each lesion at each visit. AS results and the number of injections before and after switching treatment to IVR were compared. Results: 32 eyes of 31 patients with neovascular ARMD were included in the study. The mean follow-up period was 12.3±4.7 months. The mean duration of IVB treatment was 8.1±3.1 months followed by 4.2±1.6 months with IVR. At the beginning of the study the mean AS was 8.9, (Visual Acuity) VA : 0.99 logMAR, and Central Foveal Thickness (CFT): 312.7±81.1μ. A month after the last IVB injection, AS became 5.1, VA: 0.69 logMAR, and CFT: 210.4±80.4μ (p<0.05). Likewise, a month after the last IVR injection, AS, VA and CFT were 5.8, 0.78 logMAR, and 199.9±60.9μ, respectively. Comparison of post-injection results of IVB and IVR treatments did not reveal a statistically significant difference. Mean injection rates per patient while receiving IVB and IVR treatments were 0.46/month and 0.44/ month, respectively (p>0.05). Conclusions: This study shows that the improvement in AS, CFT, and VA, achieved with the PRN IVB treatment, seems to be maintained after switching to IVR.