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Geoffrey Broadhead, Haitao Li, Meidong Zhu, Jamie Chew, Wijeyanthy Wijeyakumar, Andrew Chang, Sydney Vitreoretinal Research Group; Macular Morphology Changes Following Intravitreal Aflibercept for Treatment-Resistant Exudative AMD. Invest. Ophthalmol. Vis. Sci. 2013;54(15):3797.
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Purpose: To evaluate the effectiveness of aflibercept in eliminating intraretinal and subretinal fluid (SRF and IRF) in patients with persistent macular fluid secondary to exudative age-related macular degeneration (AMD).
Method: Central macular thickness (CMT) measured with spectral domain optical coherence tomography (SD-OCT) from an open label, prospective intravitreal aflibercept clinical trial ((Australia-New Zealand Clinical Trials Registry, ACTRN12612000666820, registered 21/06/12, commenced 15/7/2012) was analysed. All patients had persisting macular fluid despite at least 4 anti-vascular endothelial growth factor (anti-VEGF) injections in the preceding 6 months prior to baseline aflibercept administration. Presence of SRF and IRF were defined by the location of retinal fluid by SD-OCT. Intravitreal aflibercept was administered at baseline and week 4.
Results: 42 eyes of 42 patients were included for analysis. Average age of patients was 77.7±7.9 years and 38% of participants were male. At baseline, mean CMT was 439.5 ± 144.7 µm. 5 (10%) patients presented with IRF only, 16 (32%) presented with SRF alone and 21 (42%) had both IRF and SRF. Mean CMT reduction was 80.5 µm, 93.8 µm and 113.4 µm at weeks 1, 4 and 8 post aflibercept injection respectively compared to the baseline (p<0.001 at all time points). 14 patients (33%) were fluid-free at month 1 and 25 patients (60%) showed dry macular at month 2. There was a trend toward greater likelihood of fluid free status in those with SRF only at all time points (19% of SRF patients fluid-free at week 1, 50% at week 4 and 69% at week 8, respectively), followed by those with the type of IRF and SRF combination (10% week 1, 24% week 4 and 52% week 8, respectively). The group with both SRF and IRF showed a significant reduction in CMT at month 2 compared to the SRF only group (p=0.013).
Conclusions: Intravitreal aflibercept results in remarkable reduction in IRF and SRF in patients with persistent macular fluid secondary to AMD. Aflibercept eliminated macular fluid in a substantial number of patients with all subtypes of persistent exudation. Patients with combined SRF and IRF had the greatest mean reduction in CMT at month 2.
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