Effects of Intravitreal Aflibercept on Neovascular Age-Related Macular Degeneration Resistant to Intravitreal Ranibizumab

Abstract

Purpose: To evaluate the efficacy of intravitreal aflibercept (IVA) in cases with neovascular age- related macular degeneration (AMD) resistant to intravitreal ranibizumub (IVR).

Methods: Twenty-eight eyes of 28 patients with neovascular AMD (typical AMD 7 eyes, polypoidal choroidal vasculopathy 18 eyes, retinal angiomatous proliferation 3 eyes), which had previously underwent IVR, were enrolled. Mean age was 76 ± 1.5 years. Sixteen eyes were considered as a recurrent case, responding to IVR but requiring repeated injections because of frequent recurrence. Twelve eyes were considered as a refractory case, accompanying persistent intraretinal and/or subretinal fluid despite the last 2 monthly IVRs. All eyes had switching to IVA in the PRN regimen, in which additional treatment was performed when serous retinal detachment or macular edema was present, new subretinal/retinal hemorrhage was observed, or PED developed or progressed. BCVA and central retinal thickness (CRT) on optical coherence tomography were measured periodically.

Results: Mean duration from the first IVR to the first IVA was 21 months and mean number of previous IVR was 8.1 times (range 2-29). Mean follow-up period since the switching to IVA was 8.1 months (range 6-10) and mean number of IVA for 6 months was 2.5 ± 0.14. Mean BCVA at baseline and in months 3 and 6 were 0.44 ± 0.09, 0.39 ± 0.08, and 0.39 ± 0.07, respectively. BCVA was improved by 0.3 or more LogMAR units in 3 eyes (11%). Mean CRT significantly decreased from 280 ± 13 μm at baseline to 227 ± 10 μm in month 6 (P<0.01). All eyes obtained dry macula temporally or continuously, although 6 eyes (38%) in recurrent cases and 3 eyes (25%) in refractory cases required repeated injections as did with IVR because of recurrence.

Conclusions: These findings suggested that switching from IVR to IVA might be effective for anatomical recovery even in eyes resistant to IVR, although visual improvement was limited. In some eyes with frequent recurrence by IVR, repeated IVA was also required. Further studies are needed to assess long-term efficacy of IVA.

Keywords: 412 age-related macular degeneration • 748 vascular endothelial growth factor