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Thomas Hai Le Hong, Geoffrey Broadhead, Nichole Joachim, Lily Wong, Meidong Zhu, Andrew Alexander Chang; Intravitreal Aflibercept for Treatment-Resistant Neovascular Age-Related Macular Degeneration: 2-year Outcomes. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):4593.
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To assess the efficacy of intravitreal aflibercept in patients with treatment-resistant neovascular age-related macular degeneration (nAMD) over 2 years of treatment.
Forty seven eyes of 47 participants aged 50+ years with treatment-resistant nAMD in a prospective trial were followed over 96 weeks. All participants received 3 loading injections of intravitreal aflibercept every 4 weeks followed by injections every 8 weeks over 48 weeks (7 injections). Further injections were administered on a spectral-domain optical coherence tomography (OCT)-guided treat and extend basis over the subsequent 48 weeks, the maximum interval between injections was capped at 8 weeks. All participants underwent ophthalmic examinations including best-corrected visual acuity (BCVA) in early treatment in diabetic retinopathy study (ETDRS) letters and OCT to measure central macular thickness (CMT) at every visit. Changes in mean BCVA and CMT were compared between baseline and weeks 48 and 96 using paired t tests. Pearson’s correlation was used to assess the correlation between a change in BCVA and a change in CMT.
Mean baseline BCVA and CMT was 61.6 ± 15.7 letters and 443.5 ± 140.4µm respectively. Compared to baseline, mean BCVA improved by 4.4 ± 8.1 letters (p<0.001) at week 48 and 0.8 ± 9.2 letters at week 96 (p=0.57). Compared to baseline, mean CMT reduced by 92.3 ± 152.5µm at week 48 (p<0.001) and 133.1 ± 149.0µm at week 96 (p<0.001). A mean of 7.9 ± 1.6 injections were administered between weeks 48 and 96. A change in BCVA was not correlated with a change in CMT after 48 or 96 weeks (r²=-0.01 and 0.05 respectively).
Intravitreal aflibercept is effective in reducing CMT in previously treatment-resistant nAMD over 96 weeks, however an improvement in vision was not sustained over the same period. The continued reduction in CMT and drop in visual improvement over 2 years may be due to factors such as cataract or macular atrophy.
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