The impact of intravitreal aflibercept on pigment epithelial detachement morphology in eyes with persistent subretinal fluid despite a minimum of 14 previous treatments with ranibizumab in patients with neovascular age‐related macular degeneration

Abstract

AbstractPurpose To assess the efficacy of intravitreal aflibercept (2.0 mg) in patients with treatment‐resistant neovascular age‐related macular degeneration.Methods Retrospective analysis of eyes treated with aflibercept with persistent subretinal and/or intraretinal fluid despite a minimum of 14 previous treatments with intravitreal ranibizumab (0.5 mg). All patients were switched to intravitreal aflibercept (2.0 mg) and analyzed after 3 consecutive injections and at month 4 of treatment. Main outcome measures included change in visual acuity, central foveal thickness, and the height and diameter of the largest pigment epithelial detachment on spectral domain optical coherence tomography.Results Fifteen eyes of fifteen patients were analysed. The median number of previous injections of ranibizumab was 19 (IQR 15‐22). At month four, the mean visual acuity and central retinal thickness (CRT) did not change significantly from baseline: logMAR 0.64 (95%CI‐ 0.45‐0.83) and 0.65 (0.44‐0.89; p=0.5); CRT 282 μm (233‐333 μm) and 247 μm (201‐293 μm; p=0.06). However, the maximum pigment epithelial detachment height improved significantly from 279 μm (95%CI 124‐434 μm) to 195 μm (95%CI 65‐326 μm) (p=0.03) and pigment epithelial detachment diameter decreased significantly from 2,515 μm (95%CI 1,705‐3,3324μm) to 1,833 μm (95%CI 256‐1,106 μm) (p = 0.002).Conclusion Intravitreal injections of aflibercept resulted in a significant improvement in the maximum height and width of the PED in eyes with a minimum of 14 previous injections of ranibizumab.