Functional and Structural Impact of Switching to Bevacizumab in neovascular-AMD Patients Treated with Aflibercept or Ranibizumab

PurposeTo evaluate the functional and structural outcomes in patients with neovascular age-related macular degeneration (nAMD) switched from ranibizumab or aflibercept to bevacizumab.MethodsThis retrospective study included 197 eyes of 192 patients (mean age 83 ± 6 years; 38% male). Patients previously treated with ranibizumab (n = 79) or aflibercept (n = 118) were transitioned to bevacizumab. Best-corrected visual acuity (BCVA) was recorded with ETDRS charts and converted to logMAR. Spectralis SD-OCT was used to evaluate intraretinal and subretinal fluid, presence of retinal pigment epithelium detachment (PED), PED height and central retinal thickness (CRT) at baseline and after 6 months.ResultsMean BCVA decreased from 0.4 ± 0.3 to 0.5 ± 0.4 logMAR (p = 0.048). The proportion of eyes with intraretinal or subretinal fluid rose from 27% to 69% (p = 0.017). Subgroup analysis indicated greater functional and structural worsening in younger patients and in those switched from aflibercept. Mean PED height showed a non-significant increase from 163 ± 94 to 166 ± 95 µm (p = 0.091), mean PED height showed a non-significant increase from 163 ± 94 to 166 ± 95 µm (p = 0.091). In contrast, mean CRT increased substantially from 294 ± 30 µm at baseline to 310 ± 26 at 6 months (p (p < 1 × 10^-7).ConclusionsSwitching from ranibizumab or aflibercept to bevacizumab may lead to reduced visual function and an increase in structural-OCT markers of disease activity, including greater intraretinal/subretinal fluid, CRT and worsening PED features, particularly in younger individuals and in eyes previously treated with aflibercept.