Outcomes of Intravitreal Aflibercept Use in Eyes with Recalcitrant Neovascular AMD
Investigators described the efficacy of intravitreal aflibercept on 12-month visual and anatomical outcomes in patients with neovascular age-related macular degeneration (AMD) recalcitrant to prior monthly intravitreal bevacizumab or ranibizumab in this non-comparative case series.
In this series, they examined 21 eyes of 21 AMD patients with evidence of persistent exudation (intraretinal fluid/cysts, or subretinal fluid [SRF], or both) on spectral-domain optical coherence tomography despite six or more prior intravitreal 0.5 mg ranibizumab or 1.25 mg bevacizumab (mean 29.8 ± 17.1) injections over 31.6 ± 17.4 months who were transitioned to aflibercept.
At baseline, best-corrected visual acuity (BCVA) was 0.42 ± 0.28 logarithm of minimum-angle of resolution (logMAR), central foveal thickness (CFT) was 329.38 ±102.67 µm and macular volume (MV) was 7.71 ± 1.32 mm³, the investigators noted. After 12 months of aflibercept (mean 10.2 ±1.2 injections), they reported that BCVA was 0.40 ± 0.28 logMAR (p=0.5), CFT decreased to 292.71 ± 91.35 µm (p=0.038) and MV improved to 7.33 ± 1.27 mm³ (p=0.003). In a subset of 15 eyes with a persistent fibrovascular or serous pigment epithelial detachment (PED), mean baseline PED greatest basal diameter (GBD) was 2350.9 ± 1067.6 µm and mean maximal height (MH) was 288.7 ± 175.9 µm. At 12 months, GBD improved to 1896.3 ± 782.3 µm (p=0.028), while MH decreased to 248.27 ± 146.2 µm (p=0.002).
It was discovered that, in patients with recalcitrant AMD, aflibercept led to anatomic improvement at 12 months, reduction in proportion of eyes with SRF and reduction in PED, while preserving visual acuity.