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Ambar Faridi, Loton Shippey, Thomas Hwang, Andreas Lauer, Steven Bailey, Christina Flaxel; The effects of aflibercept following bevacizumab or ranibizumab on visual acuity and central macular thickness in patients with age-related macular degeneration. Invest. Ophthalmol. Vis. Sci. 2013;54(15):3827.
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To evaluate the functional and anatomic outcomes in patients with age-related macular degeneration treated with bevacizumab or ranibizumab followed by aflibercept.
A retrospective, comparative single-center study of patients diagnosed with age-related macular degeneration was performed. Demographic information, laterality, type and number of intravitreal injection (bevacizumab or ranibizumab), point of switch to aflibercept, and corresponding visual acuity and optical coherence tomography findings were analyzed. Outcomes assessed were visual acuity and central macular thickness.
21 eyes in 19 patients with age-related macular degeneration at the Casey Eye Institute were evaluated. The mean age of patients was 79.6 years (range 59-91). 11 eyes were treated with bevacizumab alone. 4 eyes received ranibizumab alone. 6 eyes received both bevacizumab and ranibizumab. All eyes were switched to aflibercept due to lack of response to bevacizumab or ranibizumab or the need for monthly injections. At the last bevacizumab or ranibizumab injection, visual acuity averaged 20/67 (one eye had counting fingers vision) and central macular thickness 323 microns. At the switch to aflibercept, visual acuity averaged 20/84 and central macular thickness 305 microns. At the last aflibercept injection, average visual acuity was 20/78 and central macular thickness 282 microns. In 9 out of 21 eyes (43%), visual acuity improved on average by 1 line or more on the Snellen visual acuity chart. In 12 out of 21 eyes (57%), central macular thickness at the last aflibercept injection decreased by 56 microns on average compared to the last bevacizumab or ranibizumab injection.
We assessed the effect of switching from bevacizumab and/or ranibizumab to aflibercept in patients with age-related macular degeneration. On average, at the most recent aflibercept injection, 41% of eyes had improved visual acuity by 1 line or more on the Snellen visual acuity chart, and 57% of eyes had a decrease in central macular thickness. This study is limited by the small number of eyes studied. Ongoing data collection is currently being performed on a larger sample of patients at the same center. Further studies are needed to determine the efficacy and long-term effects of aflibercept versus its anti-vascular endothelial growth factor predecessors.
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