Purchase this article with an account.
Siya Huo, Felix Yan-Fay Chau, Jennifer I Lim; Long-term outcomes of intravitreal aflibercept in neovascular age-related macular degeneration with pigment epithelial detachments refractory to ranibizumab and bevacizumab. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):4594.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
Pigment epithelial detachments (PED) associated with choroidal neovascularization in eyes with neovascular age-related macular degeneration (AMD) are difficult to treat, and sometimes do not respond anatomically or visually to anti-VEGF therapy. Previously published data from our institution showed that intravitreal aflibercept may be an effective form of treatment in patients who have previously failed other anti-VEGF therapy. The goal of this study is to evaluate long-term outcomes of aflibercept in this patient population.
We performed a retrospective chart review of patients with a diagnosis of neovascular AMD with associated PED who received treatment with aflibercept after previous lack of response to ranibizumab and/or bevacizumab. Visual acuity and central subfield thickness (CST) on optical coherence tomography (OCT) were compared prior to and after aflibercept therapy. Long-term visual and anatomic outcomes were analyzed.
A total of 12 eyes of 11 patients (8 female, 3 male) were included with a mean age of 74.3 +/- 10.6 years. After between one to three treatments with intravitreal aflibercept, four eyes had complete resolution of PED with associated best-corrected visual acuity (BCVA) gain of 2.75 +/- 1.5 lines. However, only one eye maintained complete resolution while PED recurred in the other three, though PED size was smaller at recurrence (increase in 68 +/- 51.4 um). Mean time to recurrence was 127.7 +/- 76.8 days, and these eyes received continued treatment with aflibercept requiring 8 +/- 5.6 re-treatments during the follow-up period, with one eye also receiving treatment with photodynamic therapy. Despite recurrence of PED, all patients maintained their BCVA gains at 24-month follow-up. Of the remaining 8 eyes with non-resolving PEDs, 4 had significant decrease in PED size after treatment, with a 115.8 +/- 59.8 um decrease in CST on OCT and BCVA gain of 4 +/- 2.75 lines. The other 4 eyes experienced stable to worsening PED appearance, and were started on treatment alternatives.
Aflibercept therapy in neovascular AMD eyes with PED after failed response to other anti-VEGF resulted in long-term improvement in BCVA and decreased PED size on OCT in 8 of 12 eyes. Aflibercept may be an effective long-term treatment choice in patients with neovascular AMD associated with PEDs.
This PDF is available to Subscribers Only