RT Journal Article
A1 Broadhead, Geoffrey
A1 Li, Haitao
A1 Zhu, Meidong
A1 Chew, Jamie
A1 Wijeyakumar, Wijeyanthy
A1 Chang, Andrew
A1 Sydney Vitreoretinal Research Group
T1 Macular Morphology Changes Following Intravitreal Aflibercept for Treatment-Resistant Exudative AMD
JF Investigative Ophthalmology & Visual Science
JO Invest. Ophthalmol. Vis. Sci.
YR 2013
VO 54
IS 15
SP 3797
OP 3797
SN 1552-5783
AB  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. 
RD 7/25/2021