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Pigment epithelial detachment response to aflibercept in neovascular age-related macular degeneration previously refractory to ranibizumab

Session Details

Session Title: AMD II

Session Date/Time: Friday 12/09/2014 | 08:00-10:00

Paper Time: 09:04

Venue: Boulevard D

First Author: : S.De Massougnes SWITZERLAND

Co Author(s): :    A. Ambresin   W. Ferrini   I. Mantel        

Abstract Details

Purpose:

Neovascular age-related macular degeneration (nAMD) may be or become refractory to ranibizumab treatment. Previous reports have shown an improved anatomical response when switching to aflibercept in these cases. The aim of this study was to assess whether refractory cases with accompagnying pigment epithelium detachment (PED) show a beneficial effect on the PED itself, when changing from ranibizumab to aflibercept.

Setting:

Retrospective chart review of a single institution (Department of ophthalmology, University of Lausanne, Jules Gonin Eye Hospital)

Methods:

A consecutive series of patients was identified, from commercial availability of aflibercept (November 2012), with the following inclusion criteria: nAMD with 12 months refractory intra- or subretinal fluid on spectral domain optical coherence tomography (SD-OCT) and with associated PED of at least 150µm height, treatment switch to aflibercept and 9 months or more follow-up thereafter. Data were collected for the type of PED (degree of vascularization on fluorescein and indocyanine green angiography), the PED height on SD-OCT and visual function before and after the treatment switch.

Results:

48 eyes (39 patients, mean age 78.6 years) which fulfilled the above criteria were identified until this abstract was written. The mean number of ranibizumab injections was 25.2 (SD 12.9), previous to switching to aflibercept. The PED was vascularized in 69.2%, serous or minimally vascularized in 30.8%, and associated with an occult membrane in 71.1%. The mean PED height on SD-OCT was 295µm (SD 125) at the time of medication switch, and 262µm (SD 130) after 3 monthly aflibercept injections. Although this difference was statistically significant (p=0.002, paired t-test), it inserted into a linear decrease of the PED height from 9 months before (320µm, SD 144) to 9 months after the switch to aflibercept (233µm, SD 106). However, a non-linear step improvement of the PED height was observed after the switch in predominantly serous PED. Visual acuity remained stable, but the refractory intra- or subretinal fluid improved or disappeared in 67.5% of eyes after 3 monthly aflibercept injections.

Conclusions:

Although changing the intravitreal anti-VEGF medication in nAMD refractory to ranibizumab may show a benefit in terms of intra- and subretinal fluid, an associated PED tends to show continuous decrease in height independent of the medication change. However, there was a suggestion that predominantly serous PED may show a prompt response to aflibercept, which is greater than the overall linear trend over time.

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