Switching to ranibizumab for diabetic macular edema with persistent fluid on bevacizumab: Who is likely to benefit from the switch?

Purpose To evaluate the efficacy of switching from bevacizumab to ranibizumab in patients with diabetic macular edema (DME). Methods The medical records of 41 DME eyes which showed persistent fluid after at least three monthly bevacizumab injections, and switched to ranibizumab injection were reviewed. Each patient received a single ranibizumab injection and followed up at 1 month. Anatomic responders to ranibizumab were followed up monthly and given ranibizumab injections on an as-needed basis until 3 months. Results At 1 month, the mean central foveal thickness (CFT) decreased from 431 μm to 349 μm (P < .001), and mean best-corrected visual acuity (BCVA) improved from 20/53 to 20/48 (P = .062). Twenty-six eyes (65.9%) were classified as anatomical responders, and the mean CFT improved and maintained until 3 months (439 μm to 320 μm, P < .001) after repeated injections (mean number: 2.8), while the mean BCVA stabilized (20/59 to 20/54, P = .075) in these eyes. Dry macula were achieved in 9 of 26 eyes at least once during the follow-up period. Favorable anatomic response to ranibizumab at month 1 was related with previous partial response to bevacizumab. Conclusions Switching to ranibizumab may present an alternative option in the treatment of DME with persistent fluid after repeated bevacizumab injections, and the switch was more effective in eyes that showed partial response to previous bevacizumab.