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Hidetomo Izawa, Keiko Azuma, Aya Matsuda, Kimiko Shimizu, xue tan, Tatsuya Inoue, Ryo Obata; Two-year outcomes of intravitreal aflibercept injection for age-related macular degeneration resistant to ranibizumab. Invest. Ophthalmol. Vis. Sci. 2017;58(8):879.
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© ARVO (1962-2015); The Authors (2016-present)
To investigate visual and anatomic outcomes in response to the conversion of aflibercept treat-and-extend therapy in Japanese patients with age-related macular degeneration (AMD) and polypoidal choroidal vasculopathy (PCV) who were resistant to ranibizumab treatment.
We retrospectively reviewed medical records of 66 consecutive eyes with AMD or PCV refractory to ranibizumab, and switched to aflibercept for at least 24 months. Mean age of the participants was 74.4±7.0 years. Before switching to aflibercept, all patients had been administered 3 monthly injections of ranibizumab and judged refractory to ranibizumab based on the optical coherence tomography (OCT) findings. Aflibercept therapy started as three monthly injections and continued according to the treat-and-extend protocol. Best-corrected visual acuity (BCVA), central retinal thickness (CRT), central choroidal thickness (CCT), and frequency of injections were evaluated.
The current study consisted of 66 patients. 23 patients had AMD, 43 had PCV. Mean baseline BCVA was 0.38±0.34 logMAR. Mean logMAR BCVA in all patients improved significantly at 12 months (0.34±0.37), while it was similar to the baseline at 24 months (0.38±0.34 logMAR). In PCV eyes, VA improved from the baseline (0.39±0.34 logMAR) both at 12 months (0.32±0.39 logMAR) and at 24 months (0.34±0.36 logMAR). Mean CRT significantly decreased from baseline to 24 months (273±142 μm vs 169±96 μm, P<0.0001). Mean CCT was significantly decreased from 219±86 μm at baseline to 193±90 μm at 3 months (P<0.0001) but showed no additional decrease until 24 months (192±89 μm). Mean number of injection was 8.8±1.8 in the first year and 7.2±2.7 in the second year.
Switching to aflibercept with treat-and-extend protocol for AMD or PCV maintained BCVA and presented a significant reduction of CRT at 2 years. CCT reduced during the early stage of treatment but maintained thereafter. The visual outcome tend to be better in PCV than AMD.
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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