Purchase this article with an account.
Irene Barbazetto, Roberto Gallego-Pinazo, Michael Engelbert; Short-term vision changes after switch to aflibercept therapy for age-related macular degeneration previously treated with other antiVEGF agents. Invest. Ophthalmol. Vis. Sci. 2013;54(15):3796.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
A subset of patients previously stabilized on antiVEGF therapy and switched to aflibercept (Eylea™, Regeneron, USA) experience a decrease in visual acuity after the initial injection. The purpose of this study is to characterize these patients and to evaluate their long-term outcomes.
This is a retrospective chart review of 80 patients/ eyes (age 82.7 years; STDEV 7.15) switched from anti-VEGF therapy with ranibizumab (Lucentis™, Genentech Inc., USA) and/or bevacizumab (Avastin™, Genentech Inc., USA) to aflibercept. Best corrected visual acuity (VA), clinical and imaging findings, including spectral-domain optical coherence tomography (OCT) and fundus autofluorescene were evaluated before and after switch of therapy.
Twelve of 80 patients/ eyes (15%) experienced visual decline of an average LogMar 0.18 one month after the first aflibercept injection. The average baseline visual acuity changed from LogMar 0.41 (STDEV 0.16) to LogMar 0.57 (STDEV 0.18). During follow-up 5/12 patients continued to worsen, 7/12 returned to baseline vision or improved eve further. The mean follow-up time was 5.3 months (range 3 - 8 months). The average number of injections in this group was 5.1 (range 2 - 7). Patients with persistent worsening after switch to aflibercept were more likely to have a lower CMT at baseline when compared to patients, who improved or returned to baseline VA at the last follow-up (246.8µm vs. 317.5µm, p = 0.050). No difference was found with regard to presence or absence of subretinal fluid, cystic changes or presence of a pigment epithelial detachment on OCT.
Aflibercept therapy is generally well tolerated. Switching patients to aflibercept therapy after treatment with other antiVEGF agents may lead to transient decrease of vision in a small subset of patients, most of whom recover and improve with further treatment. These events maybe different from those in patients experiencing loss of vision during long-term antiVEGF therapy and warrant further investigation.
This PDF is available to Subscribers Only