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assem mejaddam, Aldana Rosso, Inger Westborg; Switching to Aflibercept in Ranibizumab Refractory Age-Related Macular Degeneration: a Real-World Experience from Sweden. Invest. Ophthalmol. Vis. Sci. 2017;58(8):867.
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The aim of this study is to investigate functional and anatomic outcomes of switching to aflibercept in cases with ranibizumab-refractory neovascular age-related macular degeneration (nAMD).
We conducted a retrospective observational study and reviewed data in the Swedish Macula Registry of patients from Gävleborg, Sweden, with nAMD between 2013 and 2016 who had been treated with ranibizumab injections prior to switching to aflibercept. Switch was due to continued presence or recurrence of intra- or subretinal fluid as seen on optical coherence tomography (OCT) despite ranibizumab therapy. Exclusion criteria were other ocular disease contributing to vision loss or previous vitrectomy. Aflibercept injections were administered according to Pro Renata Regimen (PRN) and best corrected visual acuity (BCVA) ETDRS letters, near vision score (using LIX chart) and central retinal thickness (CRT) were evaluated at 3, 6, and 12 months after switching therapy. Statistical comparison of BCVA, CRT and near vision score between baseline and follow-up time points was performed. Baseline was defined as date of switching from ranibizumab to aflibercept.
At baseline, the study included 35 eyes from 32 patients with mean age of 74.7 ± 6.2 SD years. The mean BCVA at baseline was 64.9 letters ± 13.1 SD and at 12 month follow up, BCVA was 67.2 letters ± 10.6 SD. The near vision score at time of switch was a mean of 9.3 ± 5.1 SD during which 2 out of the 33 eyes could not see the largest sized text (score 24). At 12 months, mean score was 9.0 ± 5.7 SD, ranging from being able to read the smallest text size (score 4) to the largest. The mean CRT at baseline was 297 ± 85 SD microns and had decreased to 241 ± 56 SD microns at 12 month follow up. There was no clinical significant difference in results based on lesion type or gender. There were no recorded adverse events during the study period.
This study of patients residing in Gävleborg in Sweden demonstrates that switching therapy to aflibercept in ranibizumab-refractory AMD leads to an improvement in the central retinal thickness during a 12-month follow up period. Visual function remained stable which is a favorable outcome of switching therapy since they previously had refractory disease. In addition, reading ability of patients, an important quality of life parameter, remained stable as well.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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