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Ai Yoneda, Kiyoshi Suzuma, Yuki Maekawa, Eiko Tsuiki, Harumi Wakiyama, Takashi Kitaoka; Retinal and choroidal blood flow changes after switching therapy from ranibizumab to aflibercept in exudative age-related macular degeneration. Invest. Ophthalmol. Vis. Sci. 2014;55(13):3949.
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To evaluate the retinal and choroidal blood flow changes after switching therapy from intravitreal ranibizumab (IVR) to intravitreal aflibercept (IVA) in exudative age-related macular degeneration (AMD).
This retrospective observational case series included 18 eyes from 18 patients (13 males, 5 females; mean age, 72.8 years) with exudative AMD resistant to treatment with ranibizumab who were switched to treatment with aflibercept. All 18 eyes had sub- or intraretinal fluid in spite of at least three previous IVR injections. After switching the therapy, each patient received 3 consecutive monthly IVA injections. Retinal blood flow at the optic disc and chorioretinal blood flow at the macula were measured by laser speckle flowgraphy before and at 1 month after each monthly IVA injection and subsequently evaluated using the mean blur rate (MBR).
Of the 18 eyes, 14 had typical AMD and 4 had polypoidal choroidal vasculopathy. The mean number of previous IVR injections was 8.2 (range, 3-17). The central macular thickness (CMT) significantly decreased from 349.4 to 286.3, 282.2, and 280.9 µm after the 1st, 2nd and 3rd IVA injection, respectively (P<0.01). Complete resolution of both sub- and intraretinal fluid occurred in 13 eyes (72.2%) after the 3rd IVA injection. Average MBR of the blood flow in the main retinal vessels at the disc area was 103.2%, 112.4%, and 111.3% after the 1st, 2nd, and 3rd IVA injection, respectively. No significant differences were observed compared to baseline (100%). Although a significant decrease of the average MBR of the chorioretinal blood flow at the macula was observed after the 1st (87.2%, P<0.01) and 2nd (87.5%, P<0.01) IVA injections, this difference disappeared after the 3rd IVA injection (96.5%).
Our findings showed that switching from IVR to IVA resulted in a reduction of the CMT, with the retinal blood flow remaining unchanged after 3 monthly IVA injections. Although the choroidal blood flow significantly decreased after the IVA injections.
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