Abstract
PurposeEvaluation of three aflibercept injections at 4-week intervals in patients with neovascular AMD showing an “insufficient anatomic response” to prior anti-VEGF therapy with ranibizumab or bevacizumab.MethodsThe retrospective analysis included 96 eyes that had received at least three intravitreal 0.5 mg ranibizumab or 1.25 mg bevacizumab injections over a period of no more than 4 months prior to switching to aflibercept. In addition, the selected eyes had to have evidence of persisting or increasing sub- or intraretinal fluid, observed in optical coherence tomography (OCT). All patients received a loading dose of three intravitreal 2 mg aflibercept injections at 4-week intervals. Evaluation included central retinal thickness (CRT) and maximum pigment epithelium (PED) height measured by spectral domain OCT and best-corrected visual acuity (BCVA) prior to the switch of therapy and 4 weeks after the third aflibercept injection.ResultsA significant reduction of mean CRT (−39 μm; p < 0.001) and maximum PED height (−46 μm; p < 0.001) as found 4 weeks after the third aflibercept injection. Eighty-two out of 96 eyes (85 %) had a PED just prior to switching to aflibercept. There was an improvement in BCVA of 1.9 letters 4 weeks after the last aflibercept injection; the vision gain, however, did not reach statistical significance (p = 0.061). The further analysis did not show any correlation of the change in CRT, maximum PED, and BCVA with the number of prior anti-VEGF treatments.ConclusionRetinal edema and PEDs regressed significantly after switching to aflibercept in patients insufficiently responding to prior therapy with ranibizumab or bevacizumab. No correlation could be found with regard to the number of prior treatments.
Highlights
The introduction of intravitreal pan anti-vascular endothelial growth factor (VEGF) blockade for neovascular age-related macular degeneration (AMD) in the last decade has had a significant beneficial impact on patients with neovascular AMD [1,2,3]
Retinal edema and pigment epithelial detachment (PED) regressed significantly after switching to aflibercept in patients insufficiently responding to prior therapy with ranibizumab or bevacizumab
Several studies have shown that a reduced anatomic response can be found for ranibizumab and bevacizumab in neovascular AMD over time [6, 7]
Summary
The introduction of intravitreal pan anti-vascular endothelial growth factor (VEGF) blockade for neovascular age-related macular degeneration (AMD) in the last decade has had a significant beneficial impact on patients with neovascular AMD [1,2,3]. Information on long-term functional outcomes on anti-VEGF therapy in neovascular AMD are sparse and limited by decreasing number of patients in follow-up. A 7-year follow-up study on ranibizumab indicates a mean vision loss of more than 8 letters and 34 % of patients having a loss of at least 3 lines in vision at the final visit [4]. The vision loss in long-term follow-up is probably multifactorial. It includes natural progression of the underlying nonneovascular AMD, too few anti-VEGF treatments despite a still active disease, and the loss of treatment effectiveness over time [5]. Several studies have shown that a reduced anatomic response can be found for ranibizumab and bevacizumab in neovascular AMD over time [6, 7]. The terms used for this finding, range from tolerance or tachyphylaxis to resistance
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