Conversion to aflibercept for patients with neovascular age-related macular degeneration who were refractory to ranibizumab treatment

Abstract

Purpose: To evaluate the visual and anatomic outcomes of patients with neovascular age-related macular degeneration (AMD) or polypoidal choroidal vasculopathy (PCV) who were refractory to ranibizumab and were converted to aflibercept.

Methods: We included the patients with AMD or PCV who were treated with ranibizumab for longer than 6 months and showed recurrent or residual exudative changes after consecutive 3 times of injections. All these patients were switched to 3 monthly and following bi-monthly injections of aflibercept (2.0mg). We investigated the changes in visual acuity, central foveal thickness, and the height of the subfoveal pigment epithelial detachment as determined with optical coherence tomography after 6 months.

Results: Forty-one eyes of 41 patients were included. There were 15 AMD patients and 26 PCV patients. The average number of previous injections with anti-vascular endothelial growth factor agents was 10.9 ± 8.3 times. At the 6-months follow-up, mean visual acuity and central foveal thickness improved significantly from 0.40 ± 0.36 logMAR unit and 138.1 ± 78.7 μm at baseline to 0.34 ± 0.39 logMAR unit (P < 0.001) and 130.7 ± 55.9 μm (P = 0.007), respectively. Maximum height of the pigment epithelial detachment improved significantly from 134.5 ± 127.3 μm to 102.5 ± 125.8 μm (P < 0.001). In addition, the improvement of visual acuity was significantly better in patients with PCV than in patients with AMD (-0.09 ± 0.14 vs. 0.00 ± 0.10, P = 0.021).

Conclusions: Switching to aflibercept is beneficial for cases with exudative AMD and PCV who were refractory to ranibizumab. The beneficial effect of switching treatment might be greater in PCV than in typical AMD.

Keywords: 412 age-related macular degeneration • 550 imaging/image analysis: clinical • 503 drug toxicity/drug effects