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Natalie Homer, Dilraj Singh Grewal, Alice T Lyon, Rukhsana Mirza, Manjot Gill; Transitioning Neovascular Age Related Macular Degeneration Patients to Aflibercept Following an Initial Treat And Extend Dosing Regimen: 18 Month Results. Invest. Ophthalmol. Vis. Sci. 2014;55(13):3975.
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To evaluate the number of injections, visual and anatomical outcomes of patients with neovascular age-related macular degeneration (nAMD) who were transitioned to intravitreal aflibercept following an initial "treat and extend" regimen who could not be extended beyond 8 weeks with either bevacizumab or ranibizumab.
Retrospective review of patients with neovascular AMD (treated with ≥6 prior intravitreal 0.5 mg/0.05 ml ranibizumab or 1.25 mg/0.05 ml bevacizumab injections in the previous 12 months) who required treatment on a 4-8 week interval to remain exudation free and were switched to aflibercept. Three monthly aflibercept injections were followed by continued treatment at intervals increasing in some cases by 2 weeks per visit at the discretion of the treating physician. The interval was shortened if evidence of recurrent intraretinal or subretinal fluid was observed on OCT. The interval was individualized for each patient in an attempt to maintain an exudation-free macula.
21 eyes of 21 patients (18 females, 3 males; mean age 84.4±7.1 years) who had received an average of 23.8±18.8 (range 4-62) prior ranibizumab or bevacizumab injections over the prior 28±20.5 months were included. Over a mean follow-up of 18 months, mean best-corrected visual acuity (BCVA) remained stable from 0.42±0.31 logMAR at baseline to 0.42 ± 0.25 at 18 months follow-up (p=0.9). 14.2% of eyes gained ≥3 lines BCVA while 67% had stable vision (<3 line change). The mean OCT central subfoveal thickness (CFT) was stable from 292.1±83.2μm at baseline to 296.5±96.8μm at 18 months follow-up (p=0.9). The mean OCT macular volume (MV) was stable from 7.9±0.95 mm3 at baseline to 7.5±1.2mm3 at 18-months follow-up (p=0.39). The mean number of injections over the 18-month period was 6.3 ± 2.7. The mean period between injections was 57.3 days and the maximum period of extension was 133 days while the minimum was 35 days. No adverse ocular or systemic events were reported during the follow-up period.
After 18 months of transitioning to aflibercept, eyes on average received an injection every 8 weeks. Majority of the eyes had stable to improved vision and OCT anatomical parameters remained stable. This demonstrates the efficacy of aflibercept in maintaining anatomic gains while reducing the treatment burdern in eyes with nAMD.
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