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Catherine Choi, Li Zhang, Michael David Abramoff, Milan Sonka, Amde Shifera, Christine Nichols Kay; Efficacy of Aflibercept in Refractory Wet Age-Related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2014;55(13):3936.
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To investigate whether aflibercept is effective in treatment of wet age-related macular degeneration refractory to treatment with bevacizumab and/or ranibizumab using OCT segmentation and automated volume quantification, and whether 8-week treatment intervals with aflibercept could be achieved.
The study was as an IRB-approved retrospective chart review that was HIPAA-compliant. Patients included in the study were refractory to prior treatment with bevacizumab, ranibizumab, or combination of both, as defined by persistent intra-retinal or sub-retinal fluid (SRF) despite multiple treatments for a period of at least 4 months. 17 eyes in 16 patients were evaluated who had been treated by 4 independent retinal surgeons at Shands Medical Plaza in Gainesville, Florida. Patients received aflibercept injections monthly for 3 doses and were immediately extended to 8 weeks after the third dose. Subsequent dosing intervals were titrated according to OCT appearance. Patients were followed for an average of 8 months. BCVA, central foveal thickness (CFT), pigment epithelial detachment (PED) height and volume, SRF volume, interval between injections, and adverse events such as infection and inflammation were analyzed. Parameters were compared from first visit (pre-aflibercept treatment) to last documented visit (post-aflibercept treatment). Automated quantification of SRF and PED volume and CFT and PED height from OCT imaging was performed using the Iowa Reference Algorithms. Statistical analyses were completed with a two-sample, two-sided paired t-test; significance was defined as p < 0.05.
From before to after aflibercept treatment, there was a statistically significant increase in visual acuity by 2 lines, (p = 0.020), a decrease in central foveal thickness of 74.02μm (p = 0.001), a decrease in PED height of 31.9 μm (p = 0.011), and a decrease in total sub-retinal and PED volume by 1.84E+08 μm3 (p= 0.013). We found that among our patients, we could not extend treatment intervals to greater than 7.1 weeks on average without fluid recurrence. No adverse events occurred in any of the patients in this study.
Our results suggest that aflibercept is a safe and effective alternative for treatment in patients with wet ARMD who are refractory to treatment with bevacizumab and/or ranibizumab, showing significant improvement in volume of SRF and PED after switching to aflibercept therapy.
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