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Abstract
Purpose
To evaluate the efficacy of 3 bimonthly aflibercept injections for neovascular age-related macular degeneration (AMD) that showed limited response to 3 initial ranibizumab injections.
Methods
Three bimonthly aflibercept injections were performed for 21 eyes with neovascular AMD that was refractory to 3 monthly ranibizumab injections. Best-corrected visual acuity (BCVA) and central retinal thickness (CRT) were measured at diag-nosis, 1 month after 3 ranibizumab injections, and 1 month after 3 aflibercept injections, and these values were compared.
Results
The mean logarithm of minimal angle of resolution (logMAR) BCVA at diagnosis, after ranibizumab therapy, and after aflibercept therapy was 0.62 ± 0.29, 0.73 ± 0.31, and 0.65 ± 0.28, respectively. The CRT at the aforementioned times was 427.0 ± 98.7 μ m, 409.5 ± 78.7 μ m, and 315.9 ± 98.2 μ m, respectively. When compared with the value measured after ranibizumab ther-apy, CRT was significantly decreased after aflibercept therapy ( p < 0.001), whereas there was no significant difference in BCVA ( p = 0.092) between the two times. Improved BCVA was noted in 8 eyes (38.1%) after aflibercept therapy and BCVA was un-changed in 11 eyes (52.4%). Decreased CRT was noted in 18 eyes (85.7%) after aflibercept therapy.
References
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Table 1.
Baseline patient characteristics (n = 21)
| Characteristics | Value |
|---|---|
| Age (years) | 67.6 ± 6.7 |
| Sex (n, %) | |
| Men | 12 (57.1) |
| Women | 9 (42.9) |
| Diabetes mellitus | 3 (14.3) |
| Hypertension (n, %) | 14 (66.6) |
| Type of neovascular AMD (n, %)* | |
| Typical neovascular AMD | 7 (36.8) |
| Polypoidal choroidal vasculopathy | 12 (63.2) |
| Central foveal thickness (μ m) | 427.0 ± 98.7 |
| BCVA (logMAR) | 0.63 ± 0.29 |
| Values are presented as mean ± SD unless otherwise indicated. | |
Table 2.
Incidence of intraretinal fluid, subretinal fluid, and pigment epithelial detachment at the fovea at diagnosis, after 3 monthly ranibizumab injections, and after 3 bimonthly aflibercept injections (n = 21)
Figure 1.
Changes in best-corrected visual acuity (BCVA) at diagnosis, 1 month after 3 monthly intravitreal ranibizumab in-jections (After R), and 1 month after 3 bimonthly intravitreal aflibercept injections (After A) (n = 21). (A) A line-plot show-ing mean ± standard deviation values at each time point. Statistical analysis was performed using repeated-measures analysis of variances. (B) A bar-graphs showing distribution of eyes experienced different degrees of changes in visual acuity. * Comparison of visual acuity between at diagnosis and after ra-nibizumab therapy; † Comparison of visual acuity between after ranibizumab therapy and after aflibercept therapy.
Figure 2.
Changes in central foveal thickness at diagnosis, 1 month after 3 monthly intravitreal ranibizumab injections (After R), and 1 month after 3 bimonthly intravitreal afli-bercept injections (After A) (n = 21). (A) A line-plot showing mean ± standard deviation values at each time point. Statistical analysis was performed using repeated-measures analysis of variances. (B) A bar-graphs showing distribution of eyes expe-rienced different degrees of changes in central foveal thickness. * Comparison of visual acuity between at diagnosis and after ra-nibizumab therapy; † Comparison of visual acuity between after ranibizumab therapy and after aflibercept therapy.
Figure 3.
A representative case of neovascular age-related macular degeneration. Optical coherence tomography images taken at diagnosis (A), 1 month after 3 monthly intravitreal ra-nibizumab injections (B), and 1 month after 3 bimonthly intra-vitreal aflibercept injections (C). Subretinal fluid and pigment epithelial detachment did not responded to initial ranibizumab therapy. However, marked resolution of these pathologic le-sions was noted after additional aflibercept therapy.
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