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Noriko Miyamoto, Michiko Mandai, Masataka Shimozono, Takanori Kameda, Akihiro Nishida, Yasuo Kurimoto; Response and dependence to the induction therapy of intravitreal aflibercept in AMD. Invest. Ophthalmol. Vis. Sci. 2014;55(13):3835.
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We reported previously that of all treatment-naïve age-related macular degeneration (AMD) patients, 59% well-responded to ranibizumab induction therapy by achieving complete resolution of the fluid. Half of these eyes were ranibizumab-dependent requiring repeated injections and showed poorer visual outcome (2013 ARVO). In the present study, we evaluated the response and dependence to induction therapy of aflibercept which maintains significant intravitreal VEGF-binding activity for longer time compared to ranibizumab in AMD.
Medical records of 58 eyes of 54 AMD patients who received initial three monthly intravitreal aflibercept (IVA) induction therapy in our clinic from Feb to Jun 2013 were reviewed. After completion of induction therapy, all eyes were evaluated whether the complete resolution of the intra- or sub-retinal fluid was achieved by spectral-domain optical coherence tomography (SD-OCT) and were classified into well-responded (no further injection needed) or insufficiently-responded group accordingly. If the exudative change in SD-OCT images worsened within three months after completion of induction therapy, the eye was defined as treatment dependent. We thereby studied response and dependence in both naïve and converted from intravitreal ranibizumab (IVR) AMD patients.
Of 58 eyes, 28 eyes were newly treated and 30 eyes were converted from IVR. Of newly treated 28 eyes, 22 eyes (78.6 %) well responded to the induction therapy whereas 6 eyes (21.4%) had insufficient response. In well-responded group, 13 eyes (59.9%) were non-dependent and 9 eyes (40.1%) were dependent. Of 30 eyes converted from IVR, 10 eyes had been well-responded but dependent, and 20 eyes had been insufficiently-responded to IVR. Of the former, 9 eyes (90.0%) were well-responded to IVA, and of the latter, 15 eyes (75.0%) were well-responded and 5 eyes (25.0 %) were insufficiently-responded.
The effect of IVA may be more sufficient than that of IVR in AMD. Seventy-five percent of the eyes which had been insufficiently-responded to IVR well-responded to IVA.
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