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Bo Hee Kim, Young Seung Seo, Hum Chung, Jang Won Heo; Effect of Aflibercept and Bevacizumab for Ranibizumab-Refractory Exudative Age-Related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):1509.
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To compare the efficacy between aflibercept and bevacizumab in patients with exudative age-related macular degeneration (AMD) refractory to ranibizumab.
Patients with exudative AMD, who were resistant to intravitreal ranibizumab (IVR) treatment, were switched to either intravitreal aflibercept (IVA) or intravitreal bevacizumab (IVB) therapy and were followed up for six or more months. Medical records were retrospectively reviewed for visual acuity, central retinal thickness (CRT), other structural change, and the number of injections.
Seventy-eight eyes of 76 patients were included, among which 38 eyes (48.7%) were switched to IVA and 40 eyes were treated with IVB. Mean age was 69.7 ± 5.5 years and the number of previous IVR treatments was 10.5 ± 4.1 over a period of 21.2 ± 10.5 months.<br /> For six months after the therapy conversion, mean number of injection was 3.7 ± 0.8 in IVA group and 4.3 ± 1.2 in IVB group (P = 0.094). CRT at 6 months after the conversion was significantly reduced compared with baseline in the IVA group (290 ± 114 vs. 343 ± 85; P = 0.032). However, in IVB group, the reduction of CRT was only significant at 3 months after the injection (283 ± 38; P = 0.042) and no significant change was observed at the time of 6 months after the injection (301 ± 99 vs. 323 ± 85; P = 0.122). CRT was significantly lower in IVA group than in IVB group during the follow-up period. Visual acuity did not improve significantly in both groups except for a transient gain at 1 month after the injection in the IVA group.<br /> In IVA group, there were 22 eyes, which had persistent pigment epithelial detachments (PED), among which in 13 eyes (59.1%), PED was either decreased or completely disappeared. Only 5 eyes of the 24 eyes (20.8%) that initially had PED in the IVB group showed partial or complete improvement.
Aflibercept was more effective in restoring retinal structure compared to bevacizumab in patients with ranibizumab-resistant exudative AMD, especially in recovering refractory PED.
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