April 2014
Volume 55, Issue 13
ARVO Annual Meeting Abstract  |   April 2014
Efficacy of Aflibercept in Refractory Wet Age-Related Macular Degeneration
Author Affiliations & Notes
  • Catherine Choi
    Ophthalmology, University of Florida, Gainesville, FL
  • Li Zhang
    Ophthalmology, University of Iowa, Iowa City, IA
  • Michael David Abramoff
    Ophthalmology, University of Iowa, Iowa City, IA
  • Milan Sonka
    Ophthalmology, University of Iowa, Iowa City, IA
  • Amde Shifera
    Ophthalmology, University of Florida, Gainesville, FL
  • Christine Nichols Kay
    Ophthalmology, University of Florida, Gainesville, FL
  • Footnotes
    Commercial Relationships Catherine Choi, None; Li Zhang, None; Michael Abramoff, None; Milan Sonka, None; Amde Shifera, None; Christine Kay, None
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science April 2014, Vol.55, 3936. doi:https://doi.org/
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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. doi: https://doi.org/.

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      © ARVO (1962-2015); The Authors (2016-present)

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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.

Keywords: 688 retina • 696 retinal degenerations: hereditary  

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