Abstract
Purpose :
To evaluate the efficacy of bimonthly intravitreal aflibercept on refractory subretinal fluid (SRF) and/or pigment epithelial detachment (PED) in patients with neovascular age-related macular degeneration (AMD).
Methods :
Prospective, nonrandomized, interventional case series of 40 patients with persistent SRF and/or PED previously treated with at least 3 injections of intravitreal bevacizumab or ranibizumab were included. A dose of 2.0mg intravitreal aflibercept was administered as 3 initial loading doses in every 4 weeks, followed by pro re nata retreatment in every 8 weeks over 12 months upon visual acuity and optical coherence tomographic findings. Mean changes in Early Treatment Diabetic Retinopathy Study best-corrected visual acuity (BCVA), central subfield thickness (CST) and volume of SRF and/or PED were analyzed. Fluorescein angiography (FA) and indocyanine green angiography (ICGA) were also performed at both baseline and final visit.
Results :
Mean age of patients was 70.7±7.3 years old and received 7.2±5.3 times of previous intravitreal injections. Further injections following initial loading doses were made in 18 eyes (45.0%) at week 24 and 13 eyes (32.5%) at week 48. Baseline BCVA was 47.5±19.8 letters and showed no significant difference at week 48 (51.3±16.4 letters, p=0.188). Baseline CST was 319.9±94.6µm and significantly reduced to 278.3±76.6µm at week 48 (p=0.009). SRF volume was 0.52±0.64mm3 at baseline and significantly reduced to 0.25±0.36mm3 at week 48 (p=0.023). PED volume was 0.42±0.55mm3 at baseline and significantly reduced to 0.23±0.32mm3 at week 8 (p=0.003), but increased to 0.33±0.43mm3 at week 48 which showed no significant difference to baseline (p=0.350). Persistent leakage from choroidal neovascularization on FA and ICGA was observed in 23 eyes (57.5%) at final visit.
Conclusions :
Bimonthly intravitreal aflibercept is effective for reducing CST and SRF, while preserving visual acuity in treatment-resistant neovascular AMD. Despite the significant reduction after monthly loading doses, maintaining the reduction in PED volume may require more frequent injection than the bimonthly treatment.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.