title: Response to aflibercept after frequent re-treatment with bevacizumab or ranibizumab in eyes with neovascular AMD.
abstract: OBJECTIVE
  To evaluate the effects of switching to aflibercept in eyes with neovascular age-related macular degeneration (AMD) requiring frequent re-treatment with bevacizumab or ranibizumab.
  
  
  METHODS
  Retrospective review of 73 eyes of 65 patients with neovascular AMD switched to aflibercept due to persistent or recurrent macular fluid after at least 1 year of intravitreal bevacizumab or ranibizumab with re-treatment at least every 6 weeks. Minimum post-switch follow-up was 6 months. All patients were treated using a treat-and-extend strategy. The treatment intervals immediately after and before the switch were the same.
  
  
  RESULTS
  The mean pre-switch anti-VEGF therapy duration was 45 months, and the mean number of injections was 31. In the 6 months after the switch, the average number of injections was reduced by 0.6 compared with the 6 months before the switch (P < .001). Visual acuity was unchanged during this period (P = .78). Central retinal thickness (CRT) decreased by 19 µm after the switch (P < .001). Seventy eyes had vascularized retinal pigment epithelial detachments (PEDs). The decrease in the PED cube-root volume during the 6 months after the switch was statistically significant (-0.07 mm; P = .007).
  
  
  CONCLUSIONS
  The number of injections, CRT, and PED volume decreased significantly after the switch to aflibercept, but visual acuity was unchanged.
authors.forename: Mariana R
authors.initials: MR
authors.lastname: Thorell
authors.forename: Renata Portella
authors.initials: RP
authors.lastname: Nunes
authors.forename: Gene W
authors.initials: GW
authors.lastname: Chen
authors.forename: Rishi R
authors.initials: RR
authors.lastname: Doshi
authors.forename: Jyoti
authors.initials: J
authors.lastname: Dugar
authors.forename: Mathew K
authors.initials: MK
authors.lastname: George
authors.forename: Brian T
authors.initials: BT
authors.lastname: Kim
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Lowrance
authors.forename: Dimple
authors.initials: D
authors.lastname: Modi
authors.forename: Zayna
authors.initials: Z
authors.lastname: Nahas
authors.forename: Giovanni
authors.initials: G
authors.lastname: Gregori
authors.forename: Zohar
authors.initials: Z
authors.lastname: Yehoshua
authors.forename: William
authors.initials: W
authors.lastname: Feuer
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Rosenfeld
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D000068258:Bevacizumab; D057915:Drug Substitution; D005260:Female; 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*; D019233:Retreatment; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014792:Visual Acuity; D057135:Wet Macular Degeneration / Q000188:drug therapy*
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; D000068258:Bevacizumab; D040262:Receptors, Vascular Endothelial Growth Factor; D000069579:Ranibizumab