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Alexandre Sellam, Isabelle Fournier, Corinne Biton; Efficiency of aflibercept for patients suffering from wet age related macular degeneration and resistant to ranabizumab. Invest. Ophthalmol. Vis. Sci. 2014;55(13):1957.
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To evaluate anatomical and functional efficiency of intravitreal injection (IVI) aflibercept (Eylea®) for patients suffering from wet age-related macular degeneration (AMD). All patients, selected in this study, were resistant to ranabizumab (Lucentis®).
This is a retrospective French monocentric study. Due to the recent approbation of aflibercept in France (July 2013), all patients in the department of ophthalmology were switched by the usual ranibizumab to aflibercept in wet AMD. Each eye had received at least 3 IVI of ranabizumab. All eyes were resistant to ranabizumab. A new IVI of aflibercept was performed. The primary endpoint was the anatomic response after one injection of aflibercept using the mapping OCT. All patients were assessed at the one month visit. First, patients were classified into 3 groups : highly responder (normal foveolar profile), partially responder (improvement in the mapping but persistence of edema) and non-responder (profile unchanged after the IVI). The comparison of the mean central macular thickness before and after aflibercept IVI was assessed by a bilateral paired T-Student test. The secondary criterion was the functional response (EDTRS), assessed in the same way.
12 eyes of 11 patients were included. 5 eyes (42%) were totally responding to aflibercept (normal foveolar profil at the OCT); 5 eyes (42%) showed partial improvements (reduction of CMT at the OCT); 2 eyes (16%) were non responsive. There was a significant difference in mean central macular thickness one month after IVI in favour of aflibercept : 309 μ +/- 76,83 (before treatment) versus 262,17 μ +/- 51,24 (after one IVI of aflibercept) (p = 0,046). The best corrected visual acuity (EDTRS) was not improved by the IVI of aflibercept 61,75 +/-14,37 (before treatment) versus 61,25 +/-17,11 (after one IVI of aflibercept) (p = 0,70). No adverse effects have been found.
In the setting of non-responsiveness to ranabizumab aflibercept injections should be considered as a careful alternative. In this retrospective case study, our data suggest that the beginning aflibercept rescue therapy can lead a total response in 42% of cases.
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