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Yoshihiro Yonekawa, John Miller, John Loewenstein, Lucia Sobrin, Dean Eliott, Demetrios Vavvas, Joan Miller, Christopher Andreoli, Ivana Kim; Conversion to aflibercept for chronic refractory or recurrent neovascular age-related macular degeneration. Invest. Ophthalmol. Vis. Sci. 2013;54(15):1938. doi: https://doi.org/.
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To examine the outcomes of patients with refractory or recurrent neovascular age-related macular degeneration who were converted from bevacizumab and/or ranibizumab to aflibercept intravitreal injections.
This was a two-center, retrospective, interventional, non-comparative series. Treatment histories, visual acuity (VA), and central macular thickness (CMT) on spectral-domain OCT were collected. Patients were divided into “refractory” (those with persistent exudation despite monthly injections) or “recurrent” (those who required repeated injections to maintain a dry macula).
102 eyes of 94 patients were included in the study. 68 were refractory, and 34 were recurrent. A mean of 20.4 prior bevacizumab/ranibizumab injections and a mean of 3.8 aflibercept injections were administered. Mean follow-up was 18 weeks. Mean VAs were: 20/50-1 before conversion, 20/50-2 after 1 aflibercept injection (P = .723), and 20/50+2 after the final injection (P = .253). Subgroup analysis of refractory and recurrent cases also showed stable VA. Of the refractory cases, mean CMT improved after 1 injection (P < .001) and the final injection (P < .001). Intraretinal (P < .001) and subretinal (P < .001) fluid decreased after 1 injection, and the mean injection interval could be extended from 5.2 to 6.2 weeks (P = .003). Of the recurrent cases, mean CMT improved after 1 injection (P < .001) and the final injection (P < .001). Intraretinal (P = .003) and subretinal (P = .046) fluid decreased after 1 injection, and the mean injection interval could be extended from 7.2 to 9.5 weeks (P = .001).
Converting patients with chronic neovascular AMD to aflibercept may result in stabilized vision and improved anatomical outcomes, while allowing injection intervals to be extended.
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