title: Evaluation of outer retinal tubulations in eyes switched from intravitreal ranibizumab to aflibercept for treatment of exudative age-related macular degeneration.
abstract: OBJECTIVE
  To evaluate the changes of outer retinal tubulations (ORTs) as seen on spectral-domain optical coherence tomography (SD OCT) in eyes with neovascular age-related macular degeneration (AMD) where treatment was switched from intravitreal ranibizumab to intravitreal aflibercept.
  
  
  METHODS
  This was a prospective study of eyes diagnosed with neovascular AMD and previously treated with >6 intravitreal ranibizumab injections and switched to aflibercept, conducted at a single centre (Department of Ophthalmology at Pitié Salpetriere Hospital, Paris VI University) from January to July 2015. Before and after treatment was switched from ranibizumab to aflibercept, SD-OCT was used to evaluate the presence of ORTs. Additional assessments in this patient group included best-corrected visual acuity (BCVA), fluorescein angiography (FA), indocyanine green angiography (ICGA). Changes in pigment epithelium detachments (PED), presence of intraretinal cysts, and presence of subretinal fluid (SRF) were also noted.
  
  
  RESULTS
  Twenty-four eyes of 24 consecutive patients (15 female/nine male, mean age 70 years) diagnosed with neovascular AMD and previously treated with >6 intravitreal ranibizumab injections and switched to aflibercept were included in the analysis. After receiving aflibercept, patients were followed for a mean of 6.1 months. Prior to treatment switch, 97 % of eyes showed ORTs, while after treatment switch to aflibercept, at the end of the study period, 75 % had ORTs (p =  0.219). Changes in BCVA (LogMAR) were not statistically significant (1.16 ± 0.44 to 1.18 ± 1.06, p =  0.12), however, a significant reduction in central macular thickness (CMT) (from 406 μm ± 112 to 263 μm ± 68, p =  0.001), PED (from 70.8 % to 41.7 % , p =  0.016), presence of intraretinal cysts (from 83.3 % to 33.3 %, p =  0.002) and SRF (from 91.7 % to 25 %, p = 0.001 ) were noted.
  
  
  CONCLUSIONS
  After switching from ranibizumab treatment to aflibercept, ORTs remained present in 75 % of eyes, and significant reductions in CMT, PED, and SRF, and presence of intraretinal cysts were observed.
authors.affiliation: Department of Ophthalmology, Pitié salpetrière Hospital, UPMC, Paris, France.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Massamba
authors.affiliation: Department of Ophthalmology, University of Lausanne, Lausanne, Switzerland.|Fondation Asile des Aveugles (Foundation Asylum for the Blind), Jules Gonin Eye Hospital, Lausanne, Switzerland.
authors.forename: Ali
authors.initials: A
authors.lastname: Dirani
authors.affiliation: Department of Ophthalmology, Pitié salpetrière Hospital, UPMC, Paris, France.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Butel
authors.affiliation: Department of Ophthalmology, Pitié salpetrière Hospital, UPMC, Paris, France.
authors.forename: Christine
authors.initials: C
authors.lastname: Fardeau
authors.affiliation: Department of Ophthalmology, Pitié salpetrière Hospital, UPMC, Paris, France.
authors.forename: Bahram
authors.initials: B
authors.lastname: Bodaghi
authors.affiliation: Department of Ophthalmology, Pitié salpetrière Hospital, UPMC, Paris, France. aprilingram@outlook.com.|Department of Ophthalmology, University Paris VI GH Pitié Salpétrière, 47-83 Boulevard de l'hôpital 75013, Paris, France. aprilingram@outlook.com.
authors.forename: April
authors.initials: A
authors.lastname: Ingram
authors.affiliation: Department of Ophthalmology, Pitié salpetrière Hospital, UPMC, Paris, France.
authors.forename: Phuc
authors.initials: P
authors.lastname: Lehoang
mesh_terms: D000368:Aged; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage; D057915:Drug Substitution; D005260:Female; D005451:Fluorescein Angiography / Q000379:methods*; D005500:Follow-Up Studies; D005654:Fundus Oculi; D006801:Humans; D058449:Intravitreal Injections; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D000069579:Ranibizumab / Q000008:administration & dosage*; D040262:Receptors, Vascular Endothelial Growth Factor / Q000008:administration & dosage* / Q000037:antagonists & inhibitors; D011993:Recombinant Fusion Proteins / Q000008:administration & dosage*; D055214:Retinal Photoreceptor Cell Outer Segment / Q000187:drug effects / Q000473:pathology*; D041623:Tomography, Optical Coherence / Q000379:methods*; D016896:Treatment Outcome; D057135:Wet Macular Degeneration / Q000175:diagnosis / Q000188:drug therapy*
chemical_list: D020533:Angiogenesis Inhibitors; D011993:Recombinant Fusion Proteins; C533178:aflibercept; D040262:Receptors, Vascular Endothelial Growth Factor; D000069579:Ranibizumab
keywords: Aflibercept; Anti-VEGF; Exudative AMD; Outer retinal tubulations; Ranibizumab; SD-OCT