Abstract
Purpose :
Main objective of this study has been to carry out a detailed analysis of the baseline characteristics and qualitative changes in optic coherence tomography (OCT) after switch to aflibercept in patients with long-standing AMD that do not respond to ranibizumab.
Methods :
Observational, retrospective and unicentre study with a sample of 43 patients (51 eyes) with long-standing active wet AMD who started treatment with ranibizumab and in whom a switch in anti-VEGF therapy to aflibercept was made due to lack of response. Baseline characteristics were recorded, and then monthly and finally at 6 months after the switch.
A database was developed in which epidemiological, demographic, clinical and ophthalmic examination data were included as best corrected visual acuity (BCVA), eye fundus findings (hemorrhages, drusen and retinal pigment epithelial detachment (PEDs). SD-OCT (Topcon 1000) was used for the evaluation of variables such as the presence subretinal fluid, intraretinal fluid, cysts, PEDs, fibrosis, atrophy and central macular thickness (CMT).
Results :
A total of 43 patients were evaluated (22 males; 21 females). Mean age was 77.75 ± 8.75. The evolution time of wet AMD was 39.29 ± 26.3 months. The average number of previous injections was 10.94 ± 6.95. Mean BCVA (logmar) was 0.46 ± 0.28, improving one month after treatment with aflibercept but decreasing at 6 months at values of 0.49 ± 0.3. At 6 months after the change, the value of the CMT decreased from 298.72 ± 91.9 (base value) to 276 ± 90 microns (p = 0.047).
A comparative study of intraretinal fluid (IRF) was performed with the McNemar test and that feature vanish in 15 of the 26 eyes (p = 0.002) at six months.
Likewise, 45 eyes presented subretinal fluid at baseline and only 33 maintained it, assuming a reduction of 26.67% (p = 0.027).
The improvement at six months in terms of the disappareance of the cyst was remarkable. Just 18 of 30 eyes with cyst at baseline remained (p= 0.017).
Conclusions :
The switch to aflibercept in patients with AMD with long-term evolution refractory to treatment with ranibizumab does not improve the functional results at 6 months but there is an anatomical benefit that results in a significant reduction in CMT and intra-subretinal fluid.
The persistence of activity was associated to a greater progression of central macular fibrosis and atrophy.
This is a 2020 ARVO Annual Meeting abstract.