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Andrew Chang, Geoffrey Broadhead, Jamie Chew, Meidong Zhu, Haitao Li, Sydney Vitreoretinal Study Group; Short-term Effectiveness of Intravitreal Aflibercept for Persistent Exudative Age-Related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2013;54(15):3833.
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To evaluate the short-term effectiveness of intravitreal Aflibercept for patients with persistent exudative age-related macular degeneration (AMD) despite previous treatment with ranibizumab or bevacizumab.
Fifty eyes from 50 exudative AMD patients who were poorly responsive to previous anti-VEGF therapies were prospectively recruited (ANZCTR registered, ACTRN12612000666820, registered 21/06/12, commenced 15/7/2012). All participants had at least 4 consecutive anti-VEGF intravitreal injections within the preceding 6 months. Each patient received a single intravitreal aflibercept injection (2.0 mg) and was followed up to 1 month after the baseline treatment. Best-corrected visual acuity (BCVA) was assessed by ETDRS vision chart and central macular thickness (CMT) was measured by spectral domain optical coherence tomography.
The average age of participants was 77.1±7.6 years and 22 out of 50 (44%) were male. Mean number of previous ranibizumab or bevacizumab injections was 4.8±0.4 in the 6 months prior to the study enrollment. Baseline BCVA was 60.8±16.2 letters and baseline CMT was 449.3±146.8µm. Mean BCVA improvement from baseline was 3 letters at week 1 and 5 letters at month 1 (both p<0.0001). Mean CMT reduction was 91.0 µm at week 1 and 107.3 µm at month 1 compared to baseline (both p<0.0001). At month 1, 48.0% of the participants had at least one line (5 letters) improvement in BCVA and 12% of patients had at least 2-line improvement. No patient experienced vision loss greater than one line. At month 1, 79.6% of participants had CMT reduction at least 10% of their baseline measurement and 57.1% of the participants had a reduction of more than 20%. None of the participants had increased CMT more than 5% of their baseline. There were no moderate or severe adverse events associated with aflibercept injection within the observed period.
Intravitreal aflibercept was observed to produce a rapid improvement in visual acuity and reduction in CMT in eyes with persistent macular fluid. No significant safety concerns were noted during the observed period. The long-term anatomical changes and visual acuity outcomes remain to be assessed.
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