Intravitreal Aflibercept for Neovascular Age-Related Macular Degeneration Resistant to Bevacizumab and Ranibizumab

Nam Chun Cho; Woo Jin Kim; Jong Ha Kim

doi:10.3341/jkos.2015.56.9.1359

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

Original Article

J Korean Ophthalmol Soc 2015;56(9):1359-1364.

Published online: 29 August 2015

DOI: https://doi.org/10.3341/jkos.2015.56.9.1359

Intravitreal Aflibercept for Neovascular Age-Related Macular Degeneration Resistant to Bevacizumab and Ranibizumab

Nam Chun Cho, M.D, PhD^1,², Woo Jin Kim, M.D^1,^2,, Jong Ha Kim, M.D^1,²

¹Department of Ophthalmology, Chonbuk National University Medical School^¹, Jeonju, Korea

²Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University, Jeonju, Korea

Address reprint requests to Woo Jin Kim, MD Department of Ophthalmology, Chonbuk National University Hospital, #20 Geonji-ro, Deokjin-gu, Jeonju 54907, Korea Tel: 82-63-250-1965, Fax: 82-63-250-1960 E-mail: alberts123@hanmail.net

Received 15 May 201519 June 2015 Accepted 14 August 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Aflibercept, Neovascular age-related macular degeneration, Treatment-resistant

References

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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).

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).

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 (%)
IRF	5	4 (80)	1 (20)
SRF	14	11 (78.6)	3 (21.4)
PED	10	5 (50)	5 (50)

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

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