ABSTRACT
PURPOSE: To evaluate frequency of injections, visual and anatomical outcomes of neovascular age-related macular degeneration (nAMD) patients transitioned to intravitreal aflibercept after failure to extend treatment interval beyond 8 weeks with prior intravitreal bevacizumab or ranibizumab. METHODS: Retrospective review of patients with nAMD switched to aflibercept following ≥ 6 prior intravitreal ranibizumab or bevacizumab injections at 4-8-week intervals. Three monthly aflibercept injections were given followed by a treat-and-extend dosing regimen. RESULTS: Twenty-one eyes of 18 patients who had received a mean of 23.8 ± 18.8 (mean ± SD; range 6-62) prior ranibizumab or bevacizumab injections were included. Over a mean follow-up of 24 months after the transition, 9.2 ± 2.9 (range 4-21) aflibercept injections were required. Interval between aflibercept injections increased to 57.3 days (range 35-133 days), as compared with 37 ± 6.1 days (range 29-54 days) with the prior agents (P = 0.01). Mean best-corrected visual acuity was preserved (0.42 ± 0.31 vs 0.42 ± 0.23 logMAR; P = 0.2). Mean OCT central subfoveal thickness (292.1 ± 83.2 µm to 283.6 ± 78.6 µm; P = 0.4) and mean macular volume (7.9 ± 0.95 mm(3) to 7.67 ± 0.94 mm(3); P = 0.16) remained stable. CONCLUSION: Patients requiring treatment more frequently than every 8 weeks with ranibizumab and bevacizumab were transitioned to > 8-week treatment interval with aflibercept while maintaining the anatomic and visual gains.
Subject(s)
Angiogenesis Inhibitors/administration & dosage , Neovascularization, Pathologic/drug therapy , Receptors, Vascular Endothelial Growth Factor/administration & dosage , Recombinant Fusion Proteins/administration & dosage , Wet Macular Degeneration/drug therapy , Aged , Aged, 80 and over , Bevacizumab/therapeutic use , Drug Substitution , Female , Humans , Intravitreal Injections , Male , Middle Aged , Ranibizumab/therapeutic use , Retrospective Studies , Tomography, Optical Coherence , Visual AcuityABSTRACT
PURPOSE: To describe the efficacy of intravitreal aflibercept on 12-month visual and anatomical outcomes in patients with neovascular age-related macular degeneration (AMD) recalcitrant to prior monthly intravitreal bevacizumab or ranibizumab. METHODS: Non-comparative case series of 21 eyes of 21 AMD patients with evidence of persistent exudation (intraretinal fluid/cysts, or subretinal fluid (SRF), or both) on spectral domain OCT despite ≥6 prior intravitreal 0.5 mg ranibizumab or 1.25 mg bevacizumab (mean 29.8±17.1 injections) over 31.6±17.4 months who were transitioned to aflibercept. RESULTS: At baseline, best-corrected visual acuity (BCVA) was 0.42±0.28 logarithm of minimum-angle of resolution (logMAR), central foveal thickness (CFT) was 329.38±102.67 µm and macular volume (MV) was 7.71±1.32 mm(3). After 12 months of aflibercept (mean 10.2±1.2 injections), BCVA was 0.40±0.28 logMAR (P=0.5), CFT decreased to 292.71±91.35 µm (P=0.038) and MV improved to 7.33±1.27 mm(3) (P=0.003). In a subset of 15 eyes with a persistent fibrovascular or serous pigment epithelial detachment (PED), mean baseline PED greatest basal diameter (GBD) was 2350.9±1067.6 µm and mean maximal height (MH) was 288.7±175.9 µm. At 12 months, GBD improved to 1896.3±782.3 µm (P=0.028), while MH decreased to 248.27±146.2 µm (P=0.002). CONCLUSION: In patients with recalcitrant AMD, aflibercept led to anatomic improvement at 12 months, reduction in proportion of eyes with SRF and reduction in PED, while preserving visual acuity.
