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Wyatt Messenger, Peter Campbell, Ambar Faridi, Loton Shippey, Christina J Flaxel; Injection frequency and anatomic outcomes one year following conversion to aflibercept in patients with neovascular age-related macular degeneration. Invest. Ophthalmol. Vis. Sci. 2014;55(13):4932.
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To evaluate the clinical, anatomic, and functional effects of conversion to aflibercept following ranibizumab and/or bevacizumab in patients with neovascular age-related macular degeneration.
A retrospective chart review of patients with neovascular age-related macular degeneration treated with intravitreal ranibizumab and/or bevacizumab who were switched to aflibercept was performed. Demographic information, previous injection number and type, visual acuity, central macular thickness (CMT), presence of intraretinal fluid (IRF) or subretinal fluid (SRF), and dosing frequency were recorded. Patients were included if they had received at least one year of anti-VEGF therapy prior to the conversion and were followed for at least one year. The primary outcome was change in injection frequency in the year following the change. Secondary outcomes included change in CMT at 6 months and one year, presence of intraretinal and subretinal fluid at 6 months, and visual acuity at one year.
A total of 214 eyes with neovascular AMD were switched to aflibercept during the enrollment period. Of these, 109 met inclusion criteria. Compared to the year prior to starting aflibercept, injection frequency was unchanged with patients receiving 7.4 injections the year prior to conversion compared to 7.2 injections in the year following (p=0.47). However, the change to aflibercept was associated with improvement in CMT from 324 to 295 um (P = 0.0001) at 6 months, a reduction that remained significant at one year and corresponded to more patients with fluid-free retinas at one year. There was no effect on visual acuity.
In our population, switching patients to aflibercept therapy was not associated with a decrease in the mean number of injections in the first year after the conversion from ranibizumab and/or bevacizumab, or improved visual acuity, but was associated with more fluid-free eyes and improved CMT at 6 months and 1 year. It is unknown whether this will translate into improved outcomes compared with continuing the same anti-VEGF agent or will decrease the number of injections in the future.
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