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Charles Glass, Magdalena Krzystolik, Paul B Greenberg; Efficacy of Aflibercept in Treatment-Resistant Exudative Age-related Macular Degeneration: a Literature Review. Invest. Ophthalmol. Vis. Sci. 2014;55(13):3953.
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To conduct a literature review on the efficacy of intravitreal aflibercept (2.0mg) in patients with treatment-resistant exudative age-related macular degeneration (AMD).
Retrospective Pubmed literature review of all published studies evaluating the early efficacy of intravitreal Aflibercept (2.0mg) in eyes previously treated with bevicizumab and/or ranibizumab with persistent intraretinal and/or subretinal fluid. Efficacy was defined as change in intraretinal and subretinal fluid, measured by optical coherence topography (OCT), and/or change in visual acuity. Pubmed search terms were “aflibercept” and “macular degeneration”. Of the 84 articles cited in Pubmed, we identified six papers on the efficacy of aflibercept in the treatment of resistant exudative AMD: five were retrospective and one prospective. The five retrospective studies were comprised of one chart review, one observational case series, three interventional case series, and the prospective study was a noncontrolled open label clinical trial.
In all the reviewed studies, patients received at least three consecutive monthly doses of aflibercept: in two studies, patients received a mean of 3.8 and 4 doses with 4 months of follow up; in three studies, patient’s received a mean of 4.4, 5, and 5.3 doses with 6 months of follow up; and in one study, only 75% of patients continued receiving treatment after three months, and the mean number of total injections was not provided. In all the studies there was improvement in mean central foveal thickness (CFT) at all follow-up intervals (range: 18 to 89.4 microns). Two studies showed improvement in visual acuity at the 6-month follow-up interval (range: 5 - 6.9 ETDRS letter gain); the remaining four studies revealed no significant change in visual acuity. No study demonstrated a mean decrease in visual acuity.
This preliminary literature review suggests that aflibercept results in improved anatomical outcomes in patients with treatment-resistant exudative AMD. The primary limitation is short follow-up interval, and further study is needed to determine the impact of this anatomical improvement on visual outcomes
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