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Stephen Lau, Nachiketa Acharya; Efficacy of intravitreal aflibercept in exudative age-related macular degeneration (AMD) refractory to intravitreal ranibizumab and bevacizumab. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):4590.
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Published studies reported anatomical improvement with aflibercept in refractory exudative AMD patients, but the studies were small with < 50 eyes each. We performed a retrospective case review at a UK tertiary eye department to investigate the hypothesis that aflibercept reduced central macular thickness (CMT) in refractory exudative AMD patients and the correlation of the number of prior anti-VEGF injections with the change in visual acuity (VA) and CMT.
Electronic records of 128 eyes aged ≥ 50 years with persistent sub- or intra-retinal fluid on optical coherence tomography (OCT) despite anti-VEGF therapy were reviewed. Data was collected before switching to aflibercept, at 1 month after and at 2 months or the next available time after 3 initial monthly aflibercept injections. Early Treatment Diabetic Retinopathy Study (ETDRS) VA, OCT CMT and the number of prior anti-VEGF injections were recorded. The changes in VA and CMT were evaluated with paired student’s t-tests and the correlations of the number of anti-VEGF injections with the changes in VA and CMT were evaluated with Pearson coefficients. Data was analyzed with Microsoft Excel and SPSS version 22.
The number of months in the ≥ 2 months post-aflibercept group ranged from 2 to 9 with a mean of 3.7 (SD=2.3). The VA differences were insignificant at pre- versus 1 month post-aflibercept (p=0.57), pre- versus ≥ 2 months post-aflibercept (p=0.81) and 1 versus ≥ 2 months post-aflibercept (p=0.49). There was a reduction in CMT at pre- versus 1 month post-aflibercept with t(112)=-10.0, p<0.001 and pre- versus ≥ 2 months post-aflibercept with t(116)=-6.3, p<0.001. There was an increase in CMT at 1 versus ≥ 2 months post-aflibercept with t(103)=5.7, p<0.001. The number of prior anti-VEGF injections ranged from 2 to 45 with a mean of 19.6 (SD=10.1). The number of injections did not significantly correlate with the change in VA (r=0.003, p=0.49) or CMT (r=-0.135, p=0.08).
Our results confirmed that aflibercept reduced CMT without improving VA in patients refractory to other anti-VEGF drugs. The changes in VA and CMT did not correlate with the number of prior anti-VEGF injections. There was a loss of CMT reduction at 2 months post-aflibercept, so we would recommend monthly aflibercept injections in this group of patients.
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