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Dae Joong Ma, Un-Chul Park, Hyeong Gon Yu; Efficacy of aflibercept in the second eyes of neovascular age-related macular degeneration patients who refractory to bevacizumab or ranibizumab in the first eyes. Invest. Ophthalmol. Vis. Sci. 2017;58(8):899.
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To evaluate the efficacy of aflibercept in the treatment-naïve second affected eyes of bilateral neovascular age-related macular degeneration (nAMD) patients who had poor response to bevacizumab or ranibizumab in the first eyes.
We prospectively recruited 20 patients with bilateral nAMD who showed poor response to bevacizumab or ranibizumab in the first affected eyes. Poor response was defined when the patients were judged to require treatment after at least 1 year of as-needed treatment following 3 monthly injections and the following criteria were met: 1) evidence of persisted sub- or intraretinal fluid or 2) new serosanguineous pigment epithelial detachment or 3) visual loss of > 15 letters from baseline. The second affected eyes were treated for 12 months using aflibercept with fixed dosing regimen of bimonthly injection after 3 monthly loading dose.Primary outcome measures were poor response rate and the changes of visual acuity (VA) and central macular thickness (CMT) after 12 months. Secondary outcome measures were the comparisons of VA and CMT between the first and second affected eyes.
All of the second affected eyes underwent 7 intravitreal injections of aflibercept and none of them resulted in poor response after 12 month. Compared with baseline, VA and CMT were improved significantly after 12 month (54.8 ± 13.8 letters to 63.9 ± 11.9 letters, p = .001 and 322.5 ± 74.4 µm to 211.4 ± 40.3 µm, p < .000).Compared with the first affected eyes, the second eyes showed no significant difference in VA and CMT before treatment (54.8 ± 13.8 letters vs. 44.3 ± 25.0 letters, p = .348; 322.5 ± 74.4 µm vs. 324.9 ± 116.9 µm, p = .796; second vs. first eyes, respectively). After 12 months of treatment, the second affected eyes showed significant better VA and CMT compared with the first eyes (63.9 ± 11.9 letters vs. 44.0 ± 32.0 letters, p = .017; 211.4 ± 40.3 µm vs. 254.2 ± 82.2 µm, p < .001; second vs. first eyes, respectively).
In treating the second affected eyes of nAMD patients who had poor response to bevacizumab or ranibizumab in the first affected eyes, aflibercept with fixed dosing could be a better treatment option.
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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