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Mariana Rossi Thorell, Renata Portella Nunes, Giovanni Gregori, William J Feuer, Philip J Rosenfeld; Intravitreal Aflibercept in Eyes with Neovascular AMD Requiring Frequent Retreatment with Intravitreal Bevacizumab or Ranibizumab. Invest. Ophthalmol. Vis. Sci. 2014;55(13):4987. doi: https://doi.org/.
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To evaluate the effects of switching from bevacizumab or ranibizumab to aflibercept in eyes with neovascular AMD requiring frequent retreatment every 4 to 6 weeks.
A retrospective review was performed on patients with neovascular AMD undergoing anti-VEGF therapy for at least one year with persistent or recurrent macular fluid requiring retreatment every 4 to 6 weeks with intravitreal bevacizumab or ranibizumab prior to the switch to intravitreal aflibercept. Patients were followed for a minimum of 6 months after the switch. All patients were treated using a treat-and-extend strategy, and the treatment interval immediately after the switch was the same as the interval immediately before the switch. Best-corrected visual acuity (BCVA), number of injections, and SDOCT imaging measurements were collected.
A total of 72 eyes of 64 patients with neovascular AMD met the inclusion criteria during the study period. The mean duration of anti-VEGF therapy prior to the first aflibercept injection was 44.5 months (range 13.8-104.7). The mean number of total injections was 30.5 for the entire treatment period prior to the switch and 9.9 for the 12 months prior to the switch. The average number of anti-VEGF injections was reduced by 0.58 during the 6 months after the first aflibercept injection compared with the 6 months prior to the first aflibercept injection (p<0.001). BCVA increased by 0.5 letters during the 6 months after the switch to aflibercept, which was not statistically different from the 1.0 letter increase during the 6 months before the switch to aflibercept (p=0.75). Central retinal thickness did improve from 257.4 microns to 239.7 microns during the 6 months after the switch to aflibercept (p<0.001). Sixty-nine of the 72 eyes had vascularized retinal pigment epithelial detachments (PEDs). The change in PED cube-root volume 6 months after the switch to aflibercept was statistically significant (-0.08 mm, p=0.001) compared with the change in PED volume 6 months before the switch (0.02 mm, p=0.21).
The number of injections, PED volume, and central retinal thickness decreased significantly following the switch to aflibercept in eyes undergoing frequent reinjection using a treat-and-extend treatment strategy, but the BCVA did not change during the study period.
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