title: Functional and anatomic efficacy of a conversion to aflibercept in eyes with age-related macular degeneration after long-term ranibizumab treatment.
abstract: BACKGROUND
  It was the aim of this retrospective study to analyse the functional and anatomic efficacy of a conversion from ranibizumab to aflibercept treatment in eyes with exsudative age-related macular degeneration (AMD) with recently unsatisfactory response to a ranibizumab treatment.
  
  
  METHODS
  40 eyes of 37 patients (age: 80.6±7.7 years [mean±1 standard deviation (SD)] were included. The average visual acuity (VA) was 0.56±0.33 logMAR [mean±standard error (SE)] at the time of the first aflibercept injection. The eyes had received a mean of 21.5±11.7 (mean±SD) injections of ranibizumab within 3.15±1.79 (mean±SD) years. Follow-up covered 6 months in all patients. Before and after treatment and conversion of treatment, a PRN regimen with monthly visual acuity and OCT examinations was applied.
  
  
  RESULTS
  After conversion to aflibercept the mean gain of VA was 0.45±1.26 lines at month 1 (mean±SE, p=0.04), 0.26±1.60 at months 3 (p=0.067), and 0.65±1.77 (p=0.03) at month 6. Total OCT central foveal point thickness decreased from 417±215 µm (mean±1 SD) before the first injection of aflibercept to 299±139 (p<0.001), 325±174 at month 3 (p<0.001), and 321±150 µm at month 6 (p<0.001). The average number of aflibercept injections was 4.0±1.1 (mean±SD). At the end of follow up 61% of eyes had gained ≥1 line, 22%≥2 lines, and 12%≥ 3 lines. 10% had lost ≥1 line, 5%≥2 lines, and 2%≥3 lines.
  
  
  CONCLUSIONS
  The results of this case series show that conversion from ranibizumab to aflibercept can significantly reduce retinal thickness and improve visual acuity in patients with age-related macular degeneration with increasingly unsatisfactory response to long-term ranibizumab treatment.
authors.affiliation: Department of Ophthalmology, Pallas Kliniken, Olten, Switzerland (Director: Prof. Dr. Heinrich Gerding).
authors.forename: H
authors.initials: H
authors.lastname: Gerding
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination / Q000379:methods; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008268:Macular Degeneration / Q000175:diagnosis* / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D000069579:Ranibizumab / Q000008:administration & dosage*; D040262:Receptors, Vascular Endothelial Growth Factor / Q000008:administration & dosage*; D011993:Recombinant Fusion Proteins / Q000008:administration & dosage*; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014792:Visual Acuity / Q000187:drug effects*
chemical_list: D020533:Angiogenesis Inhibitors; D011993:Recombinant Fusion Proteins; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; C533178:aflibercept; D040262:Receptors, Vascular Endothelial Growth Factor; D000069579:Ranibizumab