Branch Retinal Vein Occlusion Treated with Anti VEGF, to Switch or not to Switch? Long Term Follow-Up

Abstract

Objectives To evaluate visual outcomes after switching from Bevacizumab to Ranibizumab or Aflibercept in patients with macular edema (ME) secondary to branch retinal vein occlusion (BRVO). Methods A retrospective, multi-center, observational study of BRVO patients treated with at least three Bevacizumab injections, prior to anti VEGF switch. Follow up period was 36 months and the primary study outcomes assessed changes in best corrected visual acuity (BCVA) after anti VEGF switch. Results A total of 263 eyes of 263 patients with a mean age of 71.5 ± 11.2 years of which 50% were of male gender met the inclusion criteria. Of these 175 eyes did not underwent switch while 88 eyes underwent anti-VEGF switch. There was not significant difference in mean age (p = 0.634) and gender (p = 0.269) between groups. Baseline BCVA of the no-switch group was 0.47 ± 0.43 logMAR (20/59 Snellen) Vs. 0.6 ± 0.49 logMAR (20/79 Snellen) (p = 0.031) in the switch group and at 36-months it was 0.41 ± 0.39 (20/51 Snellen) logMAR Vs. 0.54 ± 0.49 logMAR (20/69 Snellen) (p = 0.035) respectively. Difference between the rate of change in BCVA per year was insignificant between groups (p = 0.414). in multivariate analysis baseline BCVA was the single significant predictor for switch (Beta 0.137, p = 0.035). Patients with more than one anti VEGF switch suffer from decrease in BCVA. Conclusions Worse BCVA is a significant predictor for anti-VEGF switch execution, though the switch has no significant impact on the change in BCVA over time. Multiple anti VEGF switch is not recommended.