Journal List > J Korean Ophthalmol Soc > v.56(9) > 1010078

Cho, Kim, and Kim: Intravitreal Aflibercept for Neovascular Age-Related Macular Degeneration Resistant to Bevacizumab and Ranibizumab

Abstract

Purpose

To evaluate outcomes of intravitreal aflibercept in cases resistant to bevacizumab and ranibizumab in neovascular age-related macular degeneration.

Methods

Twenty patients with neovascular age-related macular generation who were resistant to treatment with bevacizumab and ranibizumab were evaluated. After switching to aflibercept the best corrected visual acuity (BCVA) and central retinal thick-ness (CRT) were compared at baseline and at 1 month after injection. Additionally, changes in the intraretinal fluid, subretinal flu-id and pigment epithelial detachment were evaluated.

Results

The mean BCVA was 0.83 ± 0.56 log MAR and the mean CRT was 294.20 ± 12.99 μ m before aflibercept treatment. After switching to aflibercept the mean BCVA was 0.86 ± 0.61 log MAR with no statistical difference ( p = 0.406) and the mean CRT was decreased to 232.45 ± 12.05 μm (p = 0.011). After 1 month of aflibercept injections, a reduction of intraretinal fluid in 4 eyes (80%), reduction of subretinal fluid in 11 eyes (78.6%) and reduction of pigment epithelial detachment in 5 eyes (50%) were observed. Increases in fluid or new lesions were not observed.

Conclusions

Aflibercept injection appears beneficial in patients with neovascular age-related macular generation who are re-sistant to bavacizumab and ranibizumab treatment.

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Figure 1.
Change in central retinal thickness from baseline to 1 month after intravitreal aflibercept injection who were re-sistant to treatment with bevacizumab and ranibizumab in neo-vascular age-related macular degeneration (Paired t-test, p = 0.011).
jkos-56-1359f1.tif
Figure 2.
A patient treated with 10th intravitreal bevacizumab and 9th intravitreal ranibizumab injection. Optical coherence tomog-raphy (OCT) showed persistent intraretinal (IRF), subretinal fluid (SRF) and pigment epithelial detachment (PED) (A). 1 month af-ter the first intravitreal aflibercept injection, OCT shows complete absorption of IRF, SRF with decreased PED (B).
jkos-56-1359f2.tif
Table 1.
Dermographic features and patient’s characteristics at baseline
Characteristics Value
Number of eyes (patients) 20 (20)
Age (years) 71.75 ± 8.07
Sex (male:female) 16:4
Previous number of injection 7.40 ± 4.52
Previous bevacizumab injection (number of eyes) 7
Previous ranibizumab injection (number of eyes) 5
Previous bevacizumab and ranibizumab injection (number of eyes) 8
Baseline mean BCVA (log MAR) 0.83 ± 0.56
Baseline mean central retinal thickness (μ m) 294.20 ± 12.99

Values are presented as mean ± SD unless otherwise indicated. SD = standard deviation; BCVA = best corrected visual acuity; log MAR = logarithm of the minimum angle of resolution.

Table 2.
Comparison of visual acuity, central macular thickness between at baseline and at 1 month after intravitreal aflibercept in-jection
Baseline At 1 month p-value
Visual acuity (log MAR) 0.83 ± 0.56 0.86 ± 0.61 0.406
Central retinal thickness (μ m) 294.20 ± 12.99 232.45 ± 12.05 0.011

Values are presented as mean ± SD unless otherwise indicated. SD = standard deviation.

Paired t-test.

Table 3.
Optical coherence tomography analysis after intravitreal aflibercept injection at 1 month
Number of eyes Resolution (%) Unchanged (%) Worse (%)
IRF 5 4 (80) 1 (20) 0 (0)
SRF 14 11 (78.6) 3 (21.4) 0 (0)
PED 10 5 (50) 5 (50) 0 (0)

IRF = intraretinal fluid; SRF = subretinal fluid; PED = pigment epithelial detachment.

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