Abstract
Purpose:
To assess the clinical response of aflibercept in the treatment of wet age related macular degeneration (AMD) following previous ranibizumab intravitreal injection (IVI).
Methods:
Patients who opted to change treatment from ranibizumab to aflibercept with an established diagnosis of wet AMD of varied subtype were identified. Ophthalmic (LogMar visual acuity (VA), injection dates, drug injected, OCT analysis) records were reviewed for each visit. Changes in recorded parameters were analysed in the year prior to switch to aflibercept to present day or end of clinical course.
Results:
37 patients, 41 eyes with wet AMD of mixed subtype receiving aflibercept had previous ranibizumab IVI. Mean age was 80 years with a F:M::21:16. Mean number of total preceding ranibizumab IVI 11.6 (range: 21 injections). Mean treatment course of ranibizumab IVI 690 days (range 1593 days). Mean follow up period of aflibercept IVI 268 days (range: 478 days). Mean number of aflibercept injections 4.5 (range 9). 60.9% of eyes (25/41) lost letters with ranibizumab treatment in the year preceding switch to aflibercept, 56% (14/25) of whom stabilised or regained letters during aflibercept treatment. 39% (16/41) had stable/improved VA with ranibizumab in the year preceding aflibercept, 50% (8/16) of whom maintained/improved VA with aflibercept.
Conclusions:
Aflibercept is effective in maintaining/improving VA in some patients losing VA with ranibizumab. A two monthly follow up schedule in patients treated with aflibercept may falsely lead clinicians to conclude a negative response or disease progression whereas significant improve was demonstrated at one month prior to re-accumulation of intraretinal/subretinal fluid by month two. Baseline loading of 3 monthly injections enabled a less ambiguous indication of clinical response when switching to aflibercept. Initial monthly follow up may enables the clinician to establish the rate of relapse and devise individualised follow up protocols. Presence of epiretinal membrane is a negative predictive indicator to response to both ranibizumab and aflibercept. Improved OCT appearance following aflibercept did not always equate to improved visual acuity.