Abstract
The prognosis of neovascular age-related macular degeneration (AMD) has been improved by anti-vascular endothelial growth factor treatments, including intravitreal aflibercept (IVA) treatment. However, many patients remain incurable. In this study, we retrospectively evaluated non-responsiveness to IVA monotherapy at 12 months in 133 eyes of 133 AMD patients. Sixty-two patients were initially treatment-naive, and 71 had received other treatments before IVA (the treatment-switched group). Mean best-corrected visual acuity (BCVA) was improved in the treatment-naive group but not in the treatment-switched group, although mean central retinal thickness (CRT) decreased in both groups. The respective percentages of non-responders as determined by worsened BCVA in the treatment-naive and treatment-switched groups were 8.1% and 15.5%, and via fundus findings, they were 12.9% and 8.5%. Multivariate analyses adjusted for age, gender, CRT, and greatest linear dimension showed that serous pigment epithelial detachment (PED) at baseline was associated with non-responsiveness in both groups as determined by BCVA and by fundus findings, and fibrovascular PED measurements indicated no response as determined by fundus findings in the treatment-switched group. The results reported herein may assist the formulation of appropriate treatment protocols for AMD patients.
Highlights
The prognosis of neovascular age-related macular degeneration (AMD) has been improved by antivascular endothelial growth factor treatments, including intravitreal aflibercept (IVA) treatment
Recent reports show that IVA can successfully treat AMD patients who are not sufficiently responsive to IVR treatment[16], and in some cases, IVA has succeeded in treating patients with serous pigment epithelial detachment (PED)[17,18], which is one of the predictive factors of non-responsiveness to IVR treatment[11]
53 eyes had been treated with a single type of anti-vascular endothelial growth factor (VEGF) drug other than aflibercept; 48 eyes had been treated only with ranibizumab, 4 eyes had been treated only with pegaptanib, and 1 eye had been treated only with bevacizumab, which is an off-label use of the drug
Summary
The prognosis of neovascular age-related macular degeneration (AMD) has been improved by antivascular endothelial growth factor treatments, including intravitreal aflibercept (IVA) treatment. Recent research has determined that vascular endothelial growth factor (VEGF) is responsible for neovascular AMD, and three types of anti-VEGF drugs have been approved: pegaptanib[6], ranibizumab[7,8], and aflibercept[9,10]. These drugs have substantially improved the prognosis of neovascular AMD patients, but notably, not all patients have satisfactory outcomes, and non-responsiveness to treatment[11,12] and tachyphylaxis to the drugs[13,14] have recently been reported. The results suggest that for apparent non-responders, it may be prudent to avoid the continuance of IVA treatment and to recommend to undertake other therapies
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