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Laura Andrea Lima Modino, Gabriela Estefania Pacheco Callirgos, Carlos Daniel Blando Labrandero, María Isabel López Gálvez; Anatomic and functional results with Aflibercept in poor-responders to Ranibizumab with long term recurrent neovascular AMD. Invest. Ophthalmol. Vis. Sci. 2019;60(9):99.
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Incomplete response to intravitreal treatment, with ranibizumab and the ideal switching moment to aflibercept is unknown. Traditionaly it is done when there is a progression of the disease and intraretinal and subretinal fluid persists. The purpose of this work is to evaluate the ideal time to change in patients with incomplete response taking into account the damage of the external retina on the OCT.
A restrospective, descriptive and transversal study, performed in long standing nAMD patients, initially treated with a loading phase of Ranibizumab, and PRN regimen during the manteinance phase and persistence of intraretinal and subretinal fluid that were switched to Aflibercept.
51 eyes of 51 patients with long standing nARMD, treated with incomplete response to Ranibizumab. All of them underwent a switch to Aflibercept and were followed fot at least 6 months. The evolution data were picked after 1, 3 and 6 months. 51% were male and 49% female with an average age of 77,75 (8,76) years.The switch to Aflibercept was performed after an average of 11.16 (6,84) injections of Ranibizumab with a medium disease evolution time of 40,08 (25,96) months.The average BCVA in logMAR at the time of the switch was of 0.47 (0.28), after one month of 0.43 (0.28), after 3 months of 0.45 (0.29), and after 6 months of 0.49 (0.3).The starting central macular spesor was of 298.72 (99.88) µm average, after 1 month 274,57 (67,64), after 3 months 262,63 (77,81), and afetr 6 months 276,64 (90,60) µm.The IRF afected patients were reduced from 30 of 51 (58,82%) at the swich to 20 (39,21%) after 6 months.The patients with SRF diminished from 46 (90,19%) to 14 (27,45) after 6 months.Fibrosis progresed from 13 patients (25,49%) at the start to 22 (43,19) after 6 months.There was a reducion of the SRF and the CME (p<0,04). Similar findings about PED but no statistical improvement of BCVA.
Acording to the obtained results, it could be said that the treatment with Aflibercept allows anatomical improvement when there is an incomplete response or no response with maintainance of their visual acuity. There were an statisticaly significative anatonic improvement in the CMS, IRF and SRF without BCVA improvement. There is a need of more studies to identify biomarkers in the SD-OCT that indicate the ideal switch moment for a better functional recovery.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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