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Vincent Hau, Mike Samuel, Michael Davis, Kristie Lin, Tom Chang; Aflibercept (Eylea) Effect on Macula Thickness and Visual Acuity in Exudative AMD Patients Recalcitrant to Ranibizumab and Bevacizumab. Invest. Ophthalmol. Vis. Sci. 2013;54(15):6270.
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© ARVO (1962-2015); The Authors (2016-present)
To investigate the effect on visual acuity and macular thickness of intravitreal injections of 2.0 mg of aflibercept (Eylea) in eyes refractive to multiple treatments of bevacizumab and/or ranibizumab in exudative age-related macular degeneration (AMD).
This study investigated 35 patients (41 eyes) with recalcitrant exudative AMD (defined as having leakage on SD OCT despite monthly 0.5 mg ranibizumab injections and/or 1.25 mg bevacizumab) after being treated with 2.0 mg aflibercept intravitreal injections. Treatment was given if any evidence of CNVM activity on FA, OCT, or clinical exam. At all visits, patients were followed with clinical examinations, Snellen visual acuities, and Spectralis OCTs. Periodic FAs and ICGs were also done prior to treatment and during follow-up.
Prior to aflibercept treatment, fluid was seen on OCT (intraretinal, subretinal, or sub-RPE) in all patients. At baseline, the median Snellen Va was 20/45 (range 20/25-20/300), mean central foveal thickness was 351.37 μm, and mean total volume was 8.52 mm3. Mean log MAR Va improved from 0.46 at pre-treatment to 0.37 at 6 months. Anatomically, mean central thickness and mean total volume improvement from baseline was 11.21 μm and 0.44 mm3 respectively at 1 month and 74.15 μm and 0.24 mm3 at 6 months. Foveal thickness at 6 months was statistically significant, whereas other end-points were not but showed a trend. No unexpected adverse effects were seen during follow-up.
Anatomic and visual acuity improvement was seen in patients given 2.0 mg aflibercept even in patients with persistent macular fluid after multiple monthly injections of ranibizumab and/or bevacizumab. This study supports the use of aflibercept as an effective treatment option for recalcitrant wet AMD patients to current standard anti-VEGF intravitreal injections.
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