Large Subretinal Haemorrhage following Change from Intravitreal Bevacizumab to Ranibizumab

Background: To report 2 cases of large subretinal haemorrhage in 2 patients with age-related macular degeneration when the intravitreal injections were changed from bevacizumab (Avastin) to ranibizumab (Lucentis). Methods: Both patients were treated initially with intravitreal bevacizumab 1.25 mg for 4 months ( 4 injections) and then switched to 0.5 mg ranibizumab which continued for another 6 months. Best-corrected visual acuity measurements, slit-lamp examination, contact lens biomicroscopy, optical coherence tomography and fluorescein angiography were performed at baseline examination and every month. Results: Both patients showed initial improvement when treated with intravitreal bevacizumab followed by deterioration and development of a large subretinal haemorrhage when changing to intravitreal ranibizumab. Conclusions: There is not enough experience switching from one anti-vascular-endothelial-growth-factor agent to another. A prospective study with large series of patients and controls may be necessary in order to determine whether it is safe enough to change from one medication to another. Copyright (C) 2009 S. Karger AG, Basel