title: Visual and anatomical outcomes of intravitreal aflibercept in eyes with persistent subfoveal fluid despite previous treatments with ranibizumab in patients with neovascular age-related macular degeneration.
abstract: OBJECTIVE
  To assess the efficacy of intravitreal aflibercept (2.0 mg) in patients with treatment-resistant neovascular age-related macular degeneration.
  
  
  METHODS
  Retrospective analysis of eyes treated with aflibercept with persistent subretinal and/or intraretinal fluid despite previous treatments with intravitreal ranibizumab (0.5 mg). All patients were switched to intravitreal aflibercept (2.0 mg) and analyzed after 3 consecutive injections and after 6 months of treatment. Main outcome measures included change in visual acuity, central foveal thickness, and the height and diameter of the pigment epithelial detachment on the subfoveal scan on optical coherence tomography.
  
  
  RESULTS
  Thirty-four eyes of 33 patients were analyzed. Mean duration of symptoms and average number of previous injections with anti-vascular endothelial growth factor agents was 44.7 ± 29.8 months (interquartile range [IQR] 24-76 months) and 28.6 ± 20.1 (IQR 10-47), respectively. At the 6-month follow-up, mean visual acuity and central foveal thickness improved significantly from 20/75 (logarithm of minimum angle of resolution 0.57 ± 0.36; IQR 0.30-1.0) and 416 ± 217 μm (IQR 263-487 μm) at baseline to 20/60 (logarithm of minimum angle of resolution 0.47 ± 0.32; IQR 0.30-0.60) (P = 0.004) and 248 ± 171 μm (IQR 235-419 μm) (P < 0.001), respectively. Maximum pigment epithelial detachment height improved significantly from 260 ± 162 μm (IQR 129-368 μm) to 214 ± 142 μm (IQR 111-305 μm) (P < 0.001) and PED diameter decreased significantly from 3,265 ± 1,622 μm (IQR 2,353-4,555 μm) to 2,949 ± 1,653 μm (IQR 1,721-4,484 μm) (P = 0.04).
  
  
  CONCLUSIONS
  Intravitreal injections of aflibercept resulted in a significant improvement in visual and anatomical outcomes in eyes with persistent subfoveal fluid despite previous treatment with ranibizumab.
authors.affiliation: Vitreous, Retina, Macula, Consultants of New York and the LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Institute, New York, NY, USA.
authors.forename: Nishant
authors.initials: N
authors.lastname: Kumar
authors.forename: Marcela
authors.initials: M
authors.lastname: Marsiglia
authors.forename: Sarah
authors.initials: S
authors.lastname: Mrejen
authors.forename: Adrian Tien-Chin
authors.initials: AT
authors.lastname: Fung
authors.forename: Jason
authors.initials: J
authors.lastname: Slakter
authors.forename: John
authors.initials: J
authors.lastname: Sorenson
authors.forename: K Bailey
authors.initials: KB
authors.lastname: Freund
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D057915:Drug Substitution; D005260:Female; D005584:Fovea Centralis / Q000473:pathology*; D006801:Humans; D058449:Intravitreal Injections; D008297:Male; D000069579:Ranibizumab; D040262:Receptors, Vascular Endothelial Growth Factor / Q000627:therapeutic use*; D011993:Recombinant Fusion Proteins / Q000627:therapeutic use*; D012163:Retinal Detachment / Q000175:diagnosis; D012189:Retrospective Studies; D058471:Subretinal Fluid / Q000187:drug effects*; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014792:Visual Acuity / Q000502:physiology*; D057135:Wet Macular Degeneration / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology
chemical_list: D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; D011993:Recombinant Fusion Proteins; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; C533178:aflibercept; D040262:Receptors, Vascular Endothelial Growth Factor; D000069579:Ranibizumab