Optical Coherence Tomographic Findings in Wet Age-Related Macular Degeneration Refractory to Bevacizumab after Intravitreal Aflibercept Therapy

Abstract

 

Purpose

 

Wet age-related macular degeneration (AMD) is associated with blindness in patient populations above 55 years of age, affecting approximately 2 million Americans. Intravitreal (IV) Bevacizumab is widely employed in the treatment of AMD. Development of a novel pharmacologic intervention to match Bevacizumab’s indications is possible with the advent of Aflibercept. This study evaluated the optical coherence tomographic (OCT) findings after IV Aflibercept therapy in patients with wet AMD refractory to IV Bevacizumab therapy.

 

Methods

 

Retrospective review of 30 patient records (male: 10, female: 20, mean age: 80 years) notable for a history of wet AMD having received at least one IV Bevacizumab injection a minimum of 4 weeks prior to initiating IV Aflibercept were reviewed. Aflibercept (2 mg IV injection) was administered by trained ophthalmologists once every 4 weeks to the study population for at least 3 months. An OCT machine (Cirrus HD-OCT Model 4000) was used to obtain high-resolution images of retinal thickness (RT) before each IV Aflibercept dose. One-way analysis of variance (ANOVA) within-subjects testing was performed using time as the independent variable (at pretreatment, 1, 2, and 3 month timepoints). RT was the dependent variable. A p value of <0.05 was considered the standard of statistical significance.

 

Results

 

Mean RT (n=30) was 317.93 microns before initiating IV Aflibercept therapy. Mean RT (n=30) was 297.53 microns prior to receiving the second injection and 280.47 microns prior to receiving the third injection. For patients receiving 4 or more injections the mean RT (n = 21) was 327.19 microns before beginning therapy and 305.52, 280.67, and 290.43 microns respectively during the following visits. Comparison between RT at all time-points achieved statistical significance (p<0.05).

 

Conclusions

 

AMD is a major cause of blindness and visual impairment in geriatric Americans. IV Aflibercept is a novel intervention developed for the treatment of wet AMD. Significant mean RT reduction after once-monthly administration of IV Aflibercept therapy for a minimum of 3 months was demonstrated in this study of 30 patients with AMD refractory to IV Bevacizumab. We recommend the use of IV Aflibercept in patients suffering from wet AMD whose disease is refractory to the current standard of care, Bevacizumab.

 

Keywords: 412 age-related macular degeneration • 561 injection • 550 imaging/image analysis: clinical