title: Intravitreal aflibercept for ranibizumab-resistant exudative age-related macular degeneration with choroidal vascular hyperpermeability.
abstract: OBJECTIVE
  To investigate anatomical responses and visual changes in cases of exudative age-related macular degeneration (AMD) with choroidal vascular hyperpermeability (CVH) that responded poorly to multiple ranibizumab injections and were treated with intravitreal aflibercept.
  
  
  METHODS
  Retrospective comparative study.
  
  
  METHODS
  Twenty-five consecutive patients attending the outpatient clinic of the University of Tokyo Hospital who showed an insufficient response to multiple intravitreal ranibizumab injections and were switched to intravitreal aflibercept injections between March and June 2013. All patients were treated with intravitreal aflibercept in a treat-and-extend regimen and followed up for at least 12 months.
  
  
  METHODS
  Presence or absence of CVH was determined by indocyanine green angiography. Changes of best-corrected visual acuity (BCVA) and central retinal thickness (CRT) at 12 months were compared between the CVH (+) AMD and CVH (-) AMD eyes.
  
  
  RESULTS
  The improvement in logMAR BCVA at 12 months was larger in the CVH (-) AMD eyes than in the CVH (+) AMD eyes (-0.18 vs -0.026; P = 0.0089, t-test). The changes in CRT did not differ significantly between the groups (-122 ± 101 μm in the CVH (-) AMD eyes and -159 ± 118 μm in the CVH (+) AMD eyes; P = 0.44, t-test). The proportion of the eyes without intraretinal or subretinal fluid or hemorrhage was 88% in the CVH (-) AMD and 67% in the CVH (+) AMD (P = 0.21, t-test).
  
  
  CONCLUSIONS
  Compared with AMD without CVH, AMD with CVH showed poorer visual gain resulting from intravitreal aflibercept treatment.
authors.affiliation: Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
authors.forename: Yoko
authors.initials: Y
authors.lastname: Nomura
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Yanagi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D002199:Capillary Permeability / Q000187:drug effects*; D002829:Choroid / Q000098:blood supply*; D004351:Drug Resistance; D005122:Exudates and Transudates; D005260:Female; D005451:Fluorescein Angiography; D005500:Follow-Up Studies; D006801:Humans; D007208:Indocyanine Green / Q000737:chemistry; D058449:Intravitreal Injections; D008297:Male; D000069579:Ranibizumab / Q000627:therapeutic use*; D040262:Receptors, Vascular Endothelial Growth Factor / Q000627:therapeutic use*; D011993:Recombinant Fusion Proteins / Q000627:therapeutic use*; D012189:Retrospective Studies; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014792:Visual Acuity / Q000502:physiology; D057135:Wet Macular Degeneration / Q000175:diagnosis / Q000188:drug therapy*
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; D007208:Indocyanine Green; D000069579:Ranibizumab