Abstract
Purpose:
To assess the efficacy of intravitreal aflibercept (2mg/0.05ml) on visual and anatomical outcomes in patients with neovascular age-related macular degeneration (AMD) with persistent disease activity recalcitrant to monthly intravitreal bevacizumab or ranibizumab injections.
Methods:
Neovascular AMD patients with evidence of persistent exudation on SD-OCT (Spectralis HRA+OCT, Heidelberg Engineering, Heidelberg, Germany), despite having received ≥6 prior intravitreal injections of 0.5 mg/0.05 ml ranibizumab or 1.25 mg/0.05 ml bevacizumab in the prior 12 months were included. Persistent exudation on SD-OCT was defined as presence of either intraretinal fluid/cysts (IRF), or subretinal fluid (SRF), or both. Non-AMD causes of choroidal neovascularization were excluded on the baseline angiogram.
Results:
Twenty-eight eyes of 24 patients (11 males, 13 females; mean age 80.6.8±4.6 years) with recalcitrant AMD who had received an average of 28.5±16.7 (range 6-70) prior ranibizumab or bevacizumab injections over a mean duration of 32.1±18.6 months were included. None of the eyes had evidence of vitreomacular traction or an epiretinal membrane at baseline. Best corrected visual acuity (BCVA), central subfoveal thickness (CFT) and macular volume (MV) using SD-OCT were evaluated at baseline and at each subsequent treatment visit. At baseline, BCVA was 0.38±0.29 logMAR (range 0- 0.9), CFT was 315.04 ± 94.15μm (216-637μm) and MV was 7.62±1.23mm3 (4.83-10.15mm3). Twenty-three of 28 eyes (82.1%) had SRF at baseline, 12/28 had IRF (42.9%) and 8/28 (28.6%) had both. After an average of 5±0.7 aflibercept injections over 6 months, mean logMAR BCVA was 0.37± 0.28 (p=0.5), mean CFT decreased to 295.5±77.77μm (range 206-609μm; p=0.008) and MV improved to 7.49±1.09 mm3 (range 5.23 to 9.02mm3; p=0.003). At 6 months follow-up there was a significant reduction in the percentage of eyes with persistent SRF to 14/28 eyes (50%, p=0.02, Fishers exact test) and IRF in 3/28 eyes (10.7%, p=0.01).
Conclusions:
In patients with recalcitrant neovascular AMD, intravitreal aflibercept led to statistically significant anatomic improvement as measured by CFT and MV and reduction in the percentage of eyes with persistent IRF or SRF. However, these anatomic gains did not translate into a significant visual improvement at 6 months follow-up.
Keywords: 453 choroid: neovascularization •
412 age-related macular degeneration •
550 imaging/image analysis: clinical