Clinical efficacy of aflibercept in non responsive to ranibizumab choroidal neovascular lesions in AMD

Abstract

 

Purpose

 

To evaluate the efficacy of aflibecept to modify the activity of CNV non responder to ranibizumab. To evaluate the variation in morphological and functional parameters after a loading phase of a different antiVEGF agent.

 

Methods

 

This prospective study included 15 eyes of 15 consecutive patients affected by CNV secondary to AMD, defined non responder to ranibizumab treatment. We included different active CNV lesions: 5 occult CNV, 7 fibrovascular DEP, 3 RAP lesions. Exclusion criteria were defined to avoid bias as extensive macular hemorrhages or lesion fibrosis, DEP with extended RIP, lesion with fibrovascular scars larger more than 2DA, patients who underwent to more than 8 ranibizumab injections. Patients at baseline were evaluated with complete ophthalmological examination, retinal angiography and SD OCT. A scheduled control visit was performed at month 4 after the aflibercept loading phase, to evaluate morphological and functional changes. A statistical analysis has been performed to evaluate the considered variables.

 

Results

 

Clinical evaluation showed interesting results about functional and morphological modifications. Mean visual acuity significantly increased from of 0,86 ± 0,29 LogMAR to 0,52±0,23 LogMAR, 6 patients reported a reduction in metamorphopsia, 5 patients a reduction in the intensity of the central scotoma. Mean retinal thickness significantly decreased from 425,54±15,16µm to 275,00±104,50µm; a reabsorption of subretinal fluid was reported in 10 patients, a reduction and disappearance of intraretinal edema and cysts was evident in 12 patients. Pigment epithelium detachment elevation was reduced in 5 of 7 patients. A significant reduction of angiographic activity was perceivable in 9 of 15 lesion studied.

 

Conclusions

 

Alfibercept appeared to be effective in modifying the natural history of ranibizumab non responders lesions. After a loading phase, morphological and functional features improved because of better control of the pathology. A longer follow up would be necessary to evaluate a long term effectiveness of the new antiVEGF agent. OCT exam appeared to be the better way to follow the lesion activity and its modifications.