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David Griffin, Preston Richmond, John Olson; Intravitreal aflibercept outcomes in patients with persistent retinal fluid with prior bevacizumab or ranibizumab treatment for neovascular age-related macular degeneration. Invest. Ophthalmol. Vis. Sci. 2014;55(13):3962.
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The objective of this study was to determine if aflibercept treatment yielded a significant reduction of central retinal thickness (CRT) and total retinal fluid volume as found on optical coherence tomography (OCT) as well as a significant improvement in visual acuity (VA) in our patient population.
Patients resistant to bevacizumab or ranibizumab treatment were switched to aflibercept injections. OCT and Snellen VA were obtained for all patients before aflibercept treatment (baseline) and following three aflibercept injections (final). OCT specifically assessed both CRT and total retinal fluid volume (including visualization of fluid in sub RPE, subretinal, and intraretinal compartments). For statistical purposes, VA was converted into logarithm of minimal angle of resolution (logMAR) values.
47 eyes (27 OD) from 47 patients met inclusion criteria. 20 patients were male and 27 female and average age was 80.5 years (SD 8.02). Prior to aflibercept treatment, our sample included 15 patients with exclusive prior bevacizumab therapy with an average 10 injections (SD 5.29), 14 patients with exclusive prior ranibizumab treatment with an average 11.14 injections (SD 7.14), and 18 patients that had received an average of 12.5 injections of either drug (SD 5.57). The patient sample as a whole had received an average 11.3 injections with any prior anti-VEGF drug (SD 5.96). The average interval between the last injection with a prior anti-VEGF drug and the first aflibercept injection was 42.9 days (SD 1.9). Baseline and final CRT were 370.57 µm (IQR 280.5-428.5) and 295.7 µm (IQR 232-335.5, p=<.001) respectively. Baseline and final total retinal fluid volumes were 4.81 mm3 (IQR 3.06-7.6) and 4.37 mm3 (IQR 2.82-7.18, p=<.001) respectively. Baseline and final logMAR for the group were 0.56 (IQR 0.29-0.99,) or 20/73 and 0.53 (IQR 0.24-0.71, p=0.301) or 20/67, respectively.
Results show statistically significant anatomical improvement in the patient sample as both central retinal thickness and total fluid volume were reduced. This indicates that anatomic improvement can be achieved in ranibizumab and bevacizumab treatment resistant patients in as few as 3 aflibercept injections. Although analysis of logMAR did show slightly enhanced visual acuity it was determined to not be statistically significant.
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