Switching therapy in patients with age-related macular degeneration, diabetic macular edema and cistoid macular edema due to retinal vein occlusion

摘要

Introduction. Intravitreal injection of anti-vascular endothelial growth factor (VEGF) agents has revolutionized the management of age-related macular degeneration (AMD), diabetic macular edema (DME), macular edemain retinal vein occlusions (RVO), and other retinal diseases accompanied byneovascular and macular edema. The aim of the study is to show the effectof switching from bevacizumab to aflibercept in patients with recalcitrantwet AMD as the best clinical approach and regimen for patients with neovascular and macular edema accompanied retinal diseases.Methods. All our patients received the intravitreal injections of 1.25 mg(0.1 mL) bevacizumab as the first treatment option, and we switched toaflibercept or triamcinolon acetonid when the therapy including bevacizumab seemed not to be effective enough, according to visual acuity andoptical coherent tomography (OCT) findings.Case presentations. We presented four cases: two patients with wet AMD,one patient with macular edema due to central retinal vein occlusion (CRVO)and one patient with DME in non-proliferative diabetic retinopathy (nPDR).The majority of our patients felt visual and anatomical improvement. Somepatients felt anatomical improvement although their visual acuity did notimprove. Switch to aflibercept had prolonged the positive effect of bavacizumab for approximately 2 months. When regular therapy including bevacizumab was reintroduced, the therapeutic effect would be prolonged.The effective clinical approach was not only the switching therapy but thecombination therapy as well. Individual treatment approach and pro renata regimen were most commonly used in our patients.Conclusion. Switching anti-VEGF drug showed positive results in patientswith refractory or recurrent wet AMD and macular edema.