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Sandrine A Zweifel, Christoph Amstutz, Johannes Fleischhauer, Malaika Kurz-Levin, Daniel Barthelmes; Preliminary results of aflibercept in treatment naïve choroidal neovascularization of neovascular age-related macular degeneration. Invest. Ophthalmol. Vis. Sci. 2014;55(13):3942.
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To evaluate the early response of aflibercept as first-line treatment in patients with newly diagnosed choroidal neovascularization (CNV) in age-related macular degeneration in a clinical setting.
Analysis of 38 eyes (35 patients, 28 female, 7 male) with treatment naïve active CNV. Lesion activity was determined based on fluorescein angiography, clinical and optical coherence tomography (OCT) findings including the presence of sub-, intraretinal fluid, retinal pigment epithelial (RPE) detachment and hemorrhage. LogMAR charts were used for testing best corrected or best available visual acuity (BCVA). Treatment response was evaluated based on change in BCVA and lesion activity.
Classic or predominantly classic CNV was diagnosed in 8 eyes (21.1%), occult or minimally classic in 22 eyes (57.9%), retinal angiomatous proliferation in 5 eyes (13.2%) and polypoidal choroidal vasculopathy in 3 eyes (7.9%). Lesion activity was evaluated as unchanged in only one eye. In all other eyes a definite treatment response was observed with complete resolution of fluid in 20 eyes after a single injection. Three eyes did not show improved sub-RPE fluid with smaller pigment epithelial detachments. A rip of the RPE was seen in 3 eyes. All patients maintained vision, 7 patients (7 eyes) gained > 15 letters from baseline to month 2 folllow-up, of which 4 reached this level of visual acuity after one injection. The visual acuity gains were maintained in this study through 6 months for the eyes with longer follow-up.
There seems to be a rapid treatment response to aflibercept independent of the underlying CNV. Aflibercept may be beneficial even in eyes with large pigment epithelial detachments due to exudative AMD.
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