Visual and anatomical outcomes following intravitreal aflibercept in eyes with recalcitrant neovascular age-related macular degeneration: 12-month results.
OBJECTIVE
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).


CONCLUSIONS
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.
Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
D S
DS
Grewal
Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
M K
MK
Gill
Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
D
D
Sarezky
Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
A T
AT
Lyon
Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
R G
RG
Mirza
D000369:Aged, 80 and over; D005260:Female; D005584:Fovea Centralis / Q000473:pathology*; D006801:Humans; D058449:Intravitreal Injections; D008297:Male; D040262:Receptors, Vascular Endothelial Growth Factor / Q000627:therapeutic use*; D011993:Recombinant Fusion Proteins / Q000627:therapeutic use*; D058471:Subretinal Fluid / Q000187:drug effects; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology*; D057135:Wet Macular Degeneration / Q000188:drug therapy* / Q000503:physiopathology
D011993:Recombinant Fusion Proteins; C533178:aflibercept; D040262:Receptors, Vascular Endothelial Growth Factor