First Author: I.Karska-Basta POLAND
Co Author(s): A. Kubicka-Trząska P. Oleksy J. Miniewicz-Kurkowska B. Romanowska-Dixon 0 0 0 0 0 0 0 0 0
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To evaluate the outcome of intravitreal injections of aflibercept in cases with exudative age-related macular degeneration (AMD) resistant to other anti-VEGF agents; bevacizumab and ranibizumab.
Patients with exudative AMD with persistent intraretinal and/or subretinal fluid after multiple injections of ranibizumab or bevacizumab were assessed and referred to as resistant to primary anti-VEGF therapy.
A retrospective chart review was conducted to identify patients with exudative AMD resistant to treatment with ranibizumab or bevacizumab who were switched to treatment with 3 monthly injections of aflibercept (Eylea, Bayer). In total, 15 eyes from 15 patients were included. Best corrected visual acuity (BCVA), central macular thickness (CMT) on optical coherence tomography (OCT), and number of injections were reviewed.
The number of prior injections with either bevacizumab or ranibizumab ranged from 3-13 (mean: 7.7). Before treatment conversion BCVA ranged from 0.05 -0.5 (mean: 0.2) and CRT was from 266 -532 µm (mean: 292 µm). Persistent subretinal fluid was present in 3 eyes, sub-RPE fluid - in 8 eyes and residual subretinal and sub-RPE fluid was detected in 4 eyes. After three monthly injections of alibercept, the BCVA improved and CRT was reduced compared with baseline, with a mean improvement of 1.2 lines of BCVA and a mean decrease of 217 µm in CRT (range: 173 – 333 µm). Eight eyes were dry after a single aflibercept injection.
Aflibercept therapy appears to be beneficial in patients with neovascular AMD who exhibit resistant intraretinal or subretinal fluid following multiple injections with either bevacizumab or ranibizumab. Further follow-up is required to determine whether BCVA and CRT improvements after aflibecept conversion can be maintained.