Intravitreal Aflibercept Group Research Articles

Comparison of One-Year Outcome of Intravitreal Aflibercept with or without Photodynamic Therapy for Polypoidal Choroidal Vasculopathy.

Background and Objectives: Our study compared the visual and anatomical outcomes of polypoidal choroidal vasculopathy (PCV) patients receiving intravitreal aflibercept (IVA) with or without photodynamic therapy (PDT) over 12 months. Materials and Methods: This retrospective study was performed for 60 eyes from 60 patients with treatment-naïve PCV. Thirty eyes were treated using IVA monotherapy (IVA group), and thirty eyes were treated using a combination of IVA with PDT (IVA/PDT group). The baseline characteristics, treatment outcomes, and retreatment rates were compared between the two groups over a one-year follow-up period. Results: The best-corrected visual acuity (BCVA) was found to have improved significantly in the IVA/PDT group at every 3-month visit. However, no significant BCVA improvement was observed in the IVA group. A significantly lower retreatment rate and higher dry macula rate were found in the IVA/PDT group than that in the IVA group. In the entire population of the study, a better baseline vision and younger age were associated with better final visual outcomes. Retreatment was associated with poor baseline BCVA and IVA monotherapy. Conclusions: The combination of IVA and PDT may offer superior visual improvement and a higher dry macula rate compared to IVA monotherapy in the treatment of PCV patients while requiring fewer retreatments over 12 months.

Aflibercept vs. dexamethasone implant for recalcitrant diabetic macular edema in pseudophakic eyes - 1-year outcomes from a quazi-randomized study in India.

To assess the safety and efficacy of intravitreal Aflibercept (IVA) versus dexamethasone (DEX) implant for treating recalcitrant diabetic macular edema (DME) in pseudophakic eyes at 1-year follow-up. Retrospective comparative case series. Data of all patients diagnosed with DME between January 2019 and December 2021, who underwent 4-monthly doses of intravitreal ranibizumab but had persistent DME [central macular thickness (CMT) within 10% of baseline value] were extracted from a computerized database. Of these, only pseudophakic eyes that underwent either IVA or DEX implant and had at least 1-year follow-up were included for analysis. DEX implant was preferred before December 2020 and IVA after this time point. In the IVA group, patients were followed up every month while DEX were followed at least every 3 months. Reinjections were considered when vision dropped by at least 1 Snellen's line or CMT increased by at least 10% from the previous visit in both groups. Comparison of change in vision and CMT at 1-year follow-up in DEX versus IVA groups. Eighty-four eyes of 84 patients aged 54.4 + 4.4 years were included, 39 (46%) received DEX and 45 (54%) received IVA. Groups were comparable for baseline vision and CMT. Vision improved equally in both groups from 0.83 + 0.15 logMAR to 0.52 + 0.10 logMAR at 3 months ( P < 0.01) and then stabilized till 1 year. However, eyes in the IVA group were 6.5 times more likely (Odds ratio = 6.45, 95% CI = 1.3 - 31.9) to achieve >3-line improvement in vision. The CMT reduction was also comparable between groups (-169 + 51 in DEX vs. -174 + 49 in IVA, P = 0.67). More eyes in the IVA group required >3 injections (91% vs. 69% in DEX, P = 0.01). The IOP was significantly higher at 6 and 9 months in the DEX group and 5 eyes (13%) required IOP lowering medications. In pseudophakic eyes with recalcitrant DME not responding to ranibizumab, switching to IVA or DEX implant results in equal visual improvement and CMT reduction. Though >3-line improvement occurs more frequently with IVA, this comes at the expense of a greater number of injections and follow-up visits.

Clinical Outcomes of Topical Bromfenac Combined with Intravitreal Aflibercept Injection for Exudative Age-related Macular Degeneration

Purpose: To evaluate the efficacy of topical bromfenac combined with intravitreal aflibercept (IVA) injection in the treatment of exudative age-related macular degeneration over a 2-year period.Methods: We retrospectively studied 43 patients (43 eyes) with exudative age-related macular degeneration. Patients were included if they received IVA injections under an as-needed protocol and had &gt; 2 years of follow-up. Among the 43 eyes, 25 received only IVA (IVA group), whereas 18 received a combination of IVA and topical bromfenac (bromfenac group). The primary outcome measure was the total number of IVA injections administered over 2 years from the initial injection compared between groups. We also compared changes in best-corrected visual acuity (BCVA) and central retinal thickness (CRT) between groups.Results: The bromfenac group received a significantly lower number of IVA injections over 2 years (7.4 ± 1.0), compared with the IVA group (9.0 ± 1.9) (&lt;i&gt;p&lt;/i&gt; &lt; 0.01). Both groups showed improvements in BCVA and CRT after 2 years compared with their baseline values. However, changes in BCVA and CRT at 2 years did not significantly differ between groups (&lt;i&gt;p&lt;/i&gt; = 0.786 and &lt;i&gt;p&lt;/i&gt; = 0.905, respectively).Conclusions: Among patients with exudative age-related macular degeneration, the total number of IVA injections over 2 years was lower in the bromfenac group than in the IVA group. More studies are needed to confirm the efficacy of topical bromfenac in a combined treatment regimen.

Comparison of Loading Dose between Aflibercept and Faricimab for Neovascular Age-Related Macular Degeneration.

Recently, faricimab was approved as the new drug for neovascular age-related macular degeneration (nAMD). We lack the knowledge to choose between the existing drug and this new drug to use for treatment-naïve nAMD cases. In this study, we compared the functional and morphologic effects in loading dose between patients with treatment-naïve nAMD treated with either intravitreal aflibercept (IVA) or intravitreal faricimab (IVF) injection in a clinical setting. This retrospective study included 30 eyes of 28 patients who started treatment with IVA between June and September 2022 and 30 eyes of 29 patients who were administered IVF between October 2022 and March 2023. All patients received three monthly IVA or IVF. The best corrected visual acuity (BCVA), central retinal thickness (CRT), and the proportion of eyes with residual exudative change at baseline and 1,2, and 3 months after initial treatment were compared between the groups. The mean BCVA significantly improved from pre-treatment after the loading dose in the IVA group (0.46 ± 0.46-0.36 ± 0.37, p = 0.0047) but not in the IVF group (0.46 ± 0.41-0.44 ± 0.45, p = 0.60). The mean CRT significantly improved in both groups. The proportion of eyes with residual exudative change was greater in the IVF group than in the IVA group 2 months after the first treatment (p = 0.026). The analysis of cases that achieved complete resolution of exudative changes after the loading dose showed that the IVA group had a significant improvement in the BCVA, whereas the IVF group did not (p = 0.0047 and 0.20, respectively). Although both IVA and IVF significantly improved CRT, the BCVA improved significantly in the IVA group but not in the IVF group.

Comparison between intravitreal brolucizumab and aflibercept in the treatment-naive central involved diabetic macular edema: One-year real-life case series.

To evaluate the effectiveness and safety of intravitreal brolucizumab (IVB) and intravitreal aflibercept (IVA) injections in the management of naive central involved diabetic macular edema (CIDME). This study included 45 treatment-naive eyes with CIDME. A complete ophthalmic examination, including BCVA and SD-OCT was performed. Patients were randomized to (IVB) or (IVA) groups. All participants received a loading phase of three consecutive intravitreal injections, then followed by a personalized treat and extend (T&E) regimen. At 12-month follow-up, the mean numbers of injections in IVA and IVB groups were 7.25 ± 0.53 and 6.3 ± 0.45, respectively (P < 0.0001). The IVA group showed a significant increase of the mean BCVA from 0.66 ± 0.15 logMAR (50.9 ± 7.7 letters) to 0.41 ± 0.19 logMAR (63.7 ± 10.8 letters). Mean CFT decreased significantly from 441.2 ± 35.7 μm to 281.3 ± 18.4 μm. The IVB group showed a significant increase of mean BCVA from 0.65 ± 0.16 logMAR (52.1 ± 7.9 letters) to 0.39 ± 0.17 logMAR (65.3 ± 8.7 letters). Mean CFT decreased significantly from 437.2 ± 41.9 μm to 275.5 ± 21.7 μm.No significant difference between both groups in terms of the vision improvement and the reduction of CFT was reported, whereas a statistical difference was observed in terms of intravitreal injections (IVI) numbers. No ocular complications were reported. This case series highlights the effectiveness of both brolucizumab and aflibercept in the treatment of CIDME with a lower frequency of injection in brolucizumab group lowering the burden of IVI in this cohort.

Neurodevelopment of patients who received intravitreal bevacizumab or aflibercept for type 1 and aggressive retinopathy of prematurity.

We aimed to compare the neurodevelopment of patients who received intravitreal bevacizumab (IVB) and intravitreal aflibercept (IVA) for type 1 retinopathy of prematurity (ROP) and aggressive ROP (A-ROP) using the Ages and Stages Questionnaire (ASQ-3) test. Patients who underwent IVB (group 1), IVA (group 2), and patients who did not receive treatment (group 3) were included in the prospective-controlled study. The patients were grouped as low-intermediate-high risk according to the high-risk infant follow-up guide. With the ASQ-3 test, fine and gross motor movements, communication, problem solving, and personal-social developments of the patients were compared. The gender distribution, birth weight (BW), and neonatal risk category of the groups were similar. Gestational age (GA) of group 1 was found to be lower compared to group 3. There was no difference between the groups in the development of gross and fine motor movements, communication and problem solving. The personal and social development of group 1 and group 2 was found to be retarded compared to the control group. As a result, the detection of retardation in the personal and social areas in the treated patients, and the detection of retardation in other areas, although not significant, reveals the necessity of following the development of these patient groups and providing the necessary support in the areas where retardation is detected.

Determining the Superiority of Vitrectomy vs Aflibercept for Treating Dense Diabetic Vitreous Hemorrhage: A Systematic Review and Meta-Analysis of Randomized Clinical Trials.

This review aimed to systematically compare the efficacy and safety of intravitreal aflibercept (IVA) and vitrectomy for treating severe vitreous hemorrhage (VH) secondary to proliferative diabetic retinopathy (PDR). The review was conducted in accordance with PRISMA guidelines. A search strategy, including the MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and US National Library of Medicine databases, was developed to identify randomized controlled trials (RCTs) that compared vitrectomy and IVA for managing VH due to PDR (participant age ≥ 18 years). The primary outcome measure was the difference in the mean visual acuity between the two treatment groups at 1, 6, and 24 months. Outcome measures included clearance of VH (in weeks), the incidence of recurrent VH, and the rate of complications. The studies were evaluated using the Cochrane Bias (ROB) tool. We identified 774 articles; six articles met the inclusion criteria, and two were ultimately included (n = 239 eyes). With or without PRP, IVA injections and vitrectomy were performed in 117 and 122 eyes, respectively. The mean BCVA at one month was significantly better in the vitrectomy group (MD=0.22, CI:0.10-0.34, p=0.0003), but no difference was found at six months (MD=0.04, CI: -0.04-0.12, p=0.356). The incidence of recurrent VH was significantly higher in the IVA group (OR=5.05, CI:2.71-9.42, p<0.0001). The probability of recurrent VH was five times greater in the IVA group than that in the vitrectomy group. There were no significant differences in the overall proportions of intra- or postoperative complications (OR=0.64, CI: 0.09-4.85, p=0.669). None of the studies had a low ROB in any of the seven domains. We conclude that IVA can be considered a viable treatment modality for diabetic VH in patients with a good follow-up. Vitrectomy initially provides better visual effect, faster VH recovery, and lower VH recurrence than IVA injections.

The efficacy of different anti-vascular endothelial growth factor agents, and dexamethasone implant therapy in patients with serous retinal detachment caused by Irvine-Gass syndrome.

The aim of this study is to compare the efficacy of intravitreal aflibercept (IVA), bevacizumab (IVB), ranibizumab (IVR), and dexamethasone implant (IVDI) in the treatment of serous retinal detachment (SRD) caused by Irvine-Gass syndrome (IGS). Retrospective cohort, comparative study. The medical records of 128 eyes with no previous history of intravitreal agents in 128 IGS patients with SRD that received IVA, IVB, IVR, and IVDI monotherapy were retrospectively reviewed. The patients were divided into 4 groups, according to treatment. Patients with recurrence and/or were unresponsive following a course of topical steroids and non-steroidal anti-inflammatory drugs (NSAIDs) were included in the study. Best corrected visual acuity (BCVA), central macular thickness (CMT), subfoveal choroidal thickness (SFCT), and SRD were compared between the 4 treatment groups at baseline, at follow-up months 1, 3, 6, and 12, and at the final follow-up visit. Serous retinal detachment completely resolved in 74%, 45.7%, 66.4%, and 40.8% of the eyes at month 1 (P = 0.042), 87%, 50.9%, 75.8%, and 80.9% at month 3 (p = 0.031), 88.9%, 50.4%, 75.7%, 80.2% at month 6 (p = 0.028), 81.7%, 72.8%, 68.7%, 80.1% at month 12 (p = 0.580), and 100%, 66.4%, 87.9%, 93.2% (p = 0.478) at final follow-up visit in the IVA, IVB, IVR, and IVDI groups, respectively. BCVA was significantly better in the IVA group at all follow-up time points (month 1: p < 0.001; month 3: p < 0.001; month 6: p = 0.002; month 12: p = 0.009, final follow-up visit: p < 0.001). CMT was significantly lower in the IVA group at months 3 (p = 0.008), 6 (p = 0.011), and 12 (p = 0.010), and at the final follow-up visit (p < 0.001). Recurrence was observed after a longer period of time and fewer injections were needed in the IVDI and IVA groups (p < 0.05). Resolution of CME was most rapid in the IVA group (p = 0.032). All intravitreal agents were effective in terms of visual results in the SRD patients; however, eyes treated with IVA and IVDI required fewer injections, as compared to the eyes treated with IVB and IVR. Furthermore, SRD entirely resolved in all eyes in the IVA group at the final follow-up visit.

Comparison of the 2-Year Results of Photodynamic Therapy with Aflibercept and Aflibercept Monotherapy for Polypoidal Choroidal Vasculopathy.

To compare the efficacies of photodynamic therapy (PDT) combined with intravitreal aflibercept (IVA) injections and IVA monotherapy using a treat-and-extend regimen (TAE) for treatment-naïve polypoidal choroidal vasculopathy (PCV). One hundred and nine eyes treated with PDT combined with IVA (PDT+IVA group: 51 eyes) or IVA monotherapy (IVA group: 58 eyes) were assessed for 2 years. The main outcome measures included best-corrected visual acuity (BCVA), central macular thickness (CMT), central choroidal thickness (CCT), number of IVA injections, and macular atrophy (MA). Polypoidal lesions before and after the loading phase were assessed using indocyanine green angiography. In both groups, BCVA significantly improved after the loading phase and was maintained for 2 years. CMT and CCT were significantly reduced in both groups, without significant differences after 2 years between the groups (P=0.2708). The mean number of IVA injections in the IVA and PDT+IVA groups during the 2 years were 13.2±3.3 and 12.7±1.8, respectively, without a significant difference (P=0.06). The frequencies of MA expansion in the IVA and PDT+IVA groups during the 2 years were 25.9% and 33.4%, respectively, with no significant difference in the incidence (odds ratio: 1.40, P=0.4253). The ratios of polyp regression after the loading phase in the IVA and PDT+IVA groups were 55.2% and 94.1%, respectively, with a significant difference (P<0.0001). PDT combined with IVA injections using a TAE regimen is effective for anatomical and visual function improvement, without a significant difference as compared to IVA monotherapy. It can facilitate complete regression of polyps with higher odds.

Short-term effects of intravitreal anti-vascular endothelial growth factor agents on body weight and multiple systems after treatment for retinopathy of prematurity.

This study's goal was to assess the short-term effect on body weight and multiple systems following intravitreal injections of ranibizumab and aflibercept for retinopathy of prematurity (ROP). We retrospectively assessed infants with ROP who received intravitreal anti-vascular endothelial growth factor agents (VEGF) treatment at our hospital. They were classified into 2 groups based on the drugs administered: the intravitreal ranibizumab (IVR) group and the intravitreal aflibercept (IVA) group. The body weight (BW) gains for the pre-treatment week, the 1st week after treatment, and the 2nd week after treatment were compared for each group. Additionally, other parameters such as blood pressure, heart rate, oxygen concentration, volume of milk and output of urine at four time points were also measured. We used repeated measurement analysis of variance analyzed these data. In total, 95 preterm infants were recruited, including 51 cases in the IVR group and 44 cases in the IVA group. The BW gain for the 1st week after treatment was significantly lower than the pre-treatment week in each group (P < 0.05), while there was no decrease in weekly BW gain in the 2nd week after treatment compared with that pre-treatment week. Based on the comparison between groups, the BW gain in the IVR group was significantly higher than in the IVA group in the second post-treatment week. Repeated measurement analysis of variance showed that there were no significant differences in blood pressure, heart rate, oxygen concentration, volume of milk and output of urine in both groups over time. IVR and IVA could have a short-term inhibitive effect on body weight gain in infants after treatment for ROP, whereas there is no significant impact on other systems.

Three year outcomes of intravitreal ranibizumab and aflibercept treatment of patients with diabetic macular edema: A comparative study.

Diabetic macular edema (DME) is the most common cause of visual deterioration in patients with diabetes mellitus. Various treatment options have been used for DME, including intravitreal injection of steroids and anti-vascular endothelial growth factors. To evaluate and compare the functional and anatomical outcomes of intravitreal ranibizumab (IVR) and intravitreal aflibercept (IVA) treatments in patients with DME. Retrospective study. Four hundred three eyes of 235 naïve patients who underwent IVR or IVA treatment for DME followed up to 36 months included in the study. Best corrected visual acuity (BCVA) and central macular thickness (CMT) were measured at baseline, year 1, 2 and 3. Primary endpoint of the study was the change in BCVA and CMT each year from baseline and requirement of additional treatment (laser/steroid injection). There were 198 eyes in IVR group and 205 eyes in IVA group. The changes in mean BCVA were 0.09 ± 0.32 versus 0.17 ± 0.41 Logarithm of the minimum angle of resolution (logMAR) (p = 0.042) at year 1, 0.09 ± 0.37 versus 0.12 ± 0.45 logMAR (p = 0.512) at year 2 and 0.13 ± 0.36 versus 0.15 ± 0.48 logMAR (p = 0.824) at year 3 in IVA and IVR groups, respectively. The baseline mean BCVA were lower (p = 0.004) in IVA group. The mean total number of injections was 7.93 ± 3.38 versus 7.42 ± 3.05 (p = 0.112). At year 1, change in mean BCVA was statistically significantly higher in IVA group; however this difference did not persist at years 2 and 3. Although the mean total number of injections was similar between groups, the requirement for adjuvant steroid treatment was significantly higher in ranibizumab group, which may affect the number of visits and treatment costs. Both ranibizumab and aflibercept treatments achieved a good long-term visual and anatomical response in DME patients.

Effect of Intravitreal Aflibercept vs Laser Photocoagulation on Treatment Success of Retinopathy of Prematurity

Laser photocoagulation, which is the standard treatment for retinopathy of prematurity (ROP), can have adverse events. Studies of anti-vascular endothelial growth factor injections have suggested efficacy in the treatment of ROP, but few studies have directly compared them with laser treatments. To compare intravitreal aflibercept vs laser photocoagulation in infants with ROP requiring treatment. This noninferiority, phase 3, 24-week, randomized clinical trial was conducted in 27 countries (64 hospital sites) throughout Asia, Europe, and South America. Overall, 118 infants (gestational age ≤32 weeks at birth or birth weight ≤1500 g) with ROP severity (zone I stage 1+ [stage 1 plus increased disease activity], zone I stage 2+, zone I stage 3, zone I stage 3+, zone II stage 2+, or zone II stage 3+) requiring treatment or with aggressive posterior ROP in at least 1 eye were enrolled between September 25, 2019, and August 28, 2020 (the last visit occurred on February 12, 2021). Infants were randomized 2:1 to receive a 0.4-mg dose of intravitreal aflibercept (n = 75) or laser photocoagulation (n = 43) at baseline. Additional treatment was allowed as prespecified. The primary outcome was the proportion of infants without active ROP and unfavorable structural outcomes 24 weeks after starting treatment (assessed by investigators). The requirement for rescue treatment was considered treatment failure. Intravitreal aflibercept was deemed noninferior if the lower limit of the 1-sided 95% bayesian credible interval for the treatment difference was greater than -5%. Among 118 infants randomized, 113 were treated (mean gestational age, 26.3 [SD, 1.9] weeks; 53 [46.9%] were female; 16.8% had aggressive posterior ROP, 19.5% had zone I ROP, and 63.7% had zone II ROP) and 104 completed the study. Treatment (intravitreal aflibercept: n = 75; laser photocoagulation: n = 38) was mostly bilateral (92.9%), and 82.2% of eyes in the intravitreal aflibercept group received 1 injection per eye. Treatment success was 85.5% with intravitreal aflibercept vs 82.1% with laser photocoagulation (between-group difference, 3.4% [1-sided 95% credible interval, -8.0% to ∞]). Rescue treatment was required in 4.8% (95% CI, 1.9% to 9.6%) of eyes in the intravitreal aflibercept group vs 11.1% (95% CI, 4.9% to 20.7%) of eyes in the laser photocoagulation group. The serious adverse event rates were 13.3% (ocular) and 24.0% (systemic) in the intravitreal aflibercept group compared with 7.9% and 36.8%, respectively, in the laser photocoagulation group. Three deaths, which occurred 4 to 9 weeks after intravitreal aflibercept treatment, were considered unrelated to aflibercept by the investigators. Among infants with ROP, intravitreal aflibercept compared with laser photocoagulation did not meet criteria for noninferiority with respect to the primary outcome of the proportion of infants achieving treatment success at week 24. Further data would be required for more definitive conclusions regarding the comparative effects of intravitreal aflibercept and laser photocoagulation in this population. ClinicalTrials.gov Identifier: NCT04004208.

Intravitreal Aflibercept versus Brolucizumab for Treatment-Naive Neovascular Age-Related Macular Degeneration with Type 1 Macular Neovascularization: Comparison of Short-Term Outcomes

Introduction: The purpose of this study was to evaluate the outcomes of loading-phase treatment with intravitreal aflibercept (IVA) or brolucizumab (IVBr) for treatment-naïve neovascular age-related macular degeneration (nAMD) associated with type 1 macular neovascularization (MNV). Methods: We retrospectively studied 108 consecutive eyes undergoing IVA and 103 consecutive eyes administered IVBr. Best-corrected visual acuity (BCVA), central macular thickness (CMT), central choroidal thickness (CCT), dry macula achievement, polypoidal lesion regression, and development of intraocular inflammation (IOI) were all assessed. Results: During the loading-phase treatment, IOI was detected in 18 eyes (17.5%) in the IVBr but none of those in the IVA group (p < 0.01). The loading-phase treatment was completed in 101 eyes in the IVA and 85 eyes in the IVBr group. In those cases, BCVA improved significantly, and CMT and CCT showed significant reductions after the loading-phase treatment in both groups (all p < 0.01). The CCT reduction was significantly greater with IVBr than with IVA (32 ± 28 μm vs. 40 ± 25 μm, p < 0.01). The dry macula achievement rate was significantly higher in the IVBr than in the IVA group (71.3 vs. 85.9%, p < 0.05). We observed complete regression of polypoidal lesions significantly more frequently with IVBr than with IVA (47.5 vs. 77.3%, p < 0.01). Discussion/Conclusion: Loading-phase treatment with IVA or IVBr for treatment-naïve nAMD with type 1 MNV effectively improved BCVA and diminished exudative changes. The CCT reduction, dry macula achievement, and polypoidal lesion regression rates were all significantly greater in the IVBr than in the IVA group. The incidence of IOI was significantly higher with IVBr than with IVA.

Long term results of three anti-vascular endothelial growth factor agents in pachychoroid neovasculopathy

Purpose To assess morphological changes and visual results in eyes with pachychoroid neovasculopathy (PNV) that underwent different intravitreal anti-vascular endothelial growth factor (VEGF) agents. Materials and methods This is a retrospective, observational, comparative study that included 76 PNV eyes in 76 patients that were allocated to three groups according to the monotherapy injection procedure, as follows: the intravitreal bevacizumab (IVB) group, intravitreal ranibizumab (IVR) group, and intravitreal aflibercept (IVA) group. Central macular thickness (CMT), best-corrected visual acuity (BCVA), and subfoveal choroidal thickness (SFCT) were measured at baseline, after treatment 1st month, 3rd month, 6th month, and 12th month, and at the final post-treatment examination. Results Mean age of the patients was 57.31 ± 5.91 years (range: 34–67 years). The mean duration of follow-up was 31.50 ± 12.91 months (range: 13–60 months). The IVB group included 30 eyes, the IVR group included 22 eyes, and the IVA group included 24 eyes. There weren’t any significant differences in BCVA changes between the groups at any post-baseline measurement time point. Although CMT did not change significantly in the IVB group from baseline to the final follow-up visit (baseline: 376.33 ± 86.31 µm; final visit: 340.80 ± 122.70 µm) (p = 0.172), CMT did change significantly in the IVA group (baseline: 383.41 ± 131.83 µm; final visit: 297.33 ± 103.81 µm) (p = 0.029) and IVR group (baseline: 379.18 ± 97.93 µm; final visit: 335.72 ± 111.45 µm) (p = 0.041). SFCT decreased significantly in the IVR and IVA groups (p = 0.015 and p < 0.001, respectively). The mean number of injections was 12.06 ± 4.72 (range: 6–20) in the IVB group, 11.81 ± 3.31(range: 7–17) in the IVR group, and 7.16 ± 3.15 (range: 4–13) in the IVA group (p = 0.004). Conclusion All three anti-VEGFs were effective in terms of visual results in patients with PNV. Patients treated with IVA required fewer injections than those treated with IVB or IVR. Furthermore, IVR and IVA treatment significantly decreased SFCT, whereas IVB did not.

Real Life Data of Treat and Extend Intravitreal Ranibizumab and Aflibercept Therapy in Wet Age-related Macular Degeneration Patients: 3-Year Results.

PurposeTo compare functional and anatomic outcome of intravitreal ranibizumab (IVR) and intravitreal aflibercept (IVA) treatments in neovascular age-related macular degeneration by using the treat and extend (TE) protocol.MethodsIn this retrospective chart study, treatment naïve 74 eyes of 74 age-related macular degeneration patients treated with IVR and IVA (38 eyes in IVR and 36 eyes in IVA group) with TE protocol were included. Following three consecutive monthly intravitreal injections, TE protocol was applied to each group. Patients were followed up for at least 36 months. Mean change in best-corrected visual acuity (BCVA), central macula thickness (CMT) and injection numbers over 3 years were compared.ResultsAmong 36 months period, the mean number of injections was 17 ± 4 for both groups (p > 0.05). In terms of CMT, there was no statistically significant difference between groups at 36 months compared to baseline. A decrease of 72.55 ± 39.37 μm in CMT was detected in IVR group, whereas the decrease was 70.58 ± 33.96 μm in IVA group (p > 0.05). There was a significant increase in BCVA at 36 months of measurements. In addition, BCVA demonstrated an increase of 4.1 ± 0.44 letters in IVR group and 4.36 ± 0.67 letters in IVA group after 36 months compared to the baseline (p > 0.05).ConclusionsBoth IVR and IVA injections provided significant improvements and stability in BCVA and CMT, however there was no significant difference between IVR and IVA injections with TE protocol of 36 months.

Comparison of the effects of aflibercept and dexamethasone in central retinal vein occlusion with serous retinal detachment

ABSTRACT Clinical relevance: Previous studies have shown the efficacy of aflibercept and dexamethasone in central retinal vein occlusion. However, the efficacy of these two drugs in central retinal vein occlusion accompanied by serous macular detachment has not been investigated and compared. This results in a search for more precise data to evaluate the effects of two drugs in real-world studies. Background: The aim of this study is to compare the efficacy of intravitreal aflibercept and dexamethasone implantation injections in central retinal vein occlusion accompanied by serous retinal detachment. Methods: Sixty-eight eyes of 68 patients with treatment-naive macular oedema post-central retinal vein occlusion were enrolled in the retrospectively designed study. All of the patients had serous retinal detachment at baseline. The patients received three intravitreal aflibercept injections with an interval of four weeks and followed by pro re nata treatment protocol (intravitreal aflibercept group, n = 37) or a single dose dexamethasone implantation injection (dexamethasone implantation group, n = 31). Best-corrected visual acuity, central retinal thickness and the height of serous retinal detachment parameters were compared at baseline, and in the first, second, third and sixth months. Results: The groups were similar in terms of baseline characteristics (p > 0.05 for all). The visual gain was greater in the intravitreal aflibercept group (p = 0.013). While the intravitreal aflibercept group had a significant central retinal thickness decrease in the first and sixth months (p = 0.011 and p = 0.001, respectively), this superiority was not observed during the entire follow-up period (p = 0.212). There was no difference in serous retinal detachment resolution between the groups (p = 0.403). Two patients in the intravitreal aflibercept group (5.4%) and five patients in the dexamethasone implantation group (16.1%) had serous retinal detachment at the final visit (p = 0.158). Conclusion: Both intravitreal aflibercept and dexamethasone implantation injections seemed to be effective in the treatment of central retinal vein occlusion with serous retinal detachment. Intravitreal aflibercept treatment yielded better results in terms of visual gain and showed a faster anatomical response.

An efficacy comparison of combination of different anti-vascular endothelial growth factors and photodynamic therapy in patients with pachychoroid neovasculopathy.

To evaluate anatomical and visual outcomes in patients who received intravitreal anti-vascular endothelial growth factor (VEGF) agents in combination with full-dose photodynamic therapy (PDT) on eyes with choroidal neovascularization (CNV) secondary to naive pachychoroid neovasculopathy (PNV). Medical records on 19 eyes of 19 patients whom intravitreal bevacizumab (IVB), intravitreal ranibizumab (IVR), and intravitreal aflibercept (IVA) injections were administered for CNV caused by PNV were enrolled into the study. The central macular thickness (CMT), best-corrected visual acuity (BCVA), and subfoveal choroidal thickness (SFCT) were recorded at the baseline, months 1, 3, 6, 12, and final control visit following treatment. The age average was 53.84 ± 5.23years (range, 46-62years), and mean follow-up time was 33.42 ± 9.43months (range, 16-49months). The change in BCVA was found statistically significant in the IVA group only during follow-up visits (p = 0.007). Although there was no statistically significant change in CMT following IVR (360.60 ± 75.64-252 ± 75.04µm) (p = 0.077), significant changes were observed in IVB (397.14 ± 122.59-275.28 ± 63.82µm) (p = 0.004) and IVA (385.85 ± 43.82-244.42 ± 51.57µm) (p = 0.005) between the baseline and the final visit. SFCT significantly decreased following both IVR and IVA treatments (p = 0.016, p = 0.039, respectively). In consideration of the number of injections, significantly fewer injections were needed in the IVA group than the others (p = 0.018). Anti-VEGF agents with full-dose PDT were well tolerated for the first 3months and were highly effective treatment option in order to naive PNV patients. However, in long-term follow-ups, the effectiveness of IVA was superior to other anti-VEGFs.

Comparison of the efficacy of aflibercept and ranibizumab after a 3-month loading dose in patients with diabetic macular edema

Background/Aim: Diabetic macular edema (DME) is the main cause of visual loss in diabetic patients. Aflibercept and ranibizumab are among the most commonly used intravitreal agents in the DME. This study aims to compare the short-term anatomic and functional results of aflibercept and ranibizumab in the treatment of DME. Methods: This retrospective cohort study included newly diagnosed and treatment-naive DME patients. The patients were administered intravitreal aflibercept (IVA) or intravitreal ranibizumab (IVR) as a loading dose throughout 3 months. Pre-treatment and 1- and 3-month examinations were made of best corrected visual acuity (BCVA)and central macular thickness (CMT). After the treatment, the patients were classified in the 3rd month as those with good or poor response according to the early anatomic response. A good response to the treatment was considered the formation of foveal contour and full recovery of macular edema. Patients where macular edema was not fully resolved and/or foveal contour had not formed were classified as having poor response. Later, IVA and IVR were compared with each other in terms of response to treatment. Results: Evaluation was made of 67 eyes of 54 patients, comprising 31 (57.4%) females and 23 (42.6%) males with a mean age of 62.7 (7.3) years (range, 46-78 years). IVA was applied to 33 (49.3%) eyes and IVR to 34 (50.7%) eyes. In the IVA group, BCVA was determined as 0.75 (0.39) LogMAR pre-treatment, 0.53 (0.37) LogMAR at 1 month and 0.38 (0.30) LogMAR at 3 months (P<0.001 for each). CMT was measured as 400 (82) µm pre-treatment, 349 (95) µm at 1 month and 313 (79) µm at 3 months (P<0.001 for each). In the IVR group, BCVA was determined as 0.71 (0.34) LogMAR pre-treatment, 0.52 (0.34) LogMAR at 1 month and 0.39 (0.30) LogMAR at 3 months (P<0.001 for each). CMT was measured as 426 (92) µm pre-treatment, 365 (74) µm at 1 month and 323 (60) µm at 3 months (P<0.001 for each). A good response to treatment was determined in 24 eyes (72.7%) in the IVA group, and in 18 eyes (52.9%) in the IVR group. Although a good response to treatment was achieved at a higher rate in the IVA group, the difference was not statistically significant (P=0.09). Conclusion: Both visual and anatomic success was achieved with a 3-month loading dose in both the IVA and IVR groups. No statistically significant superiority was determined of one drug over the other in the 3-month period.

Evaluation of the Effects of Intravitreal Aflibercept and Ranibizumab on Systemic Inflammatory and Cardiovascular Biomarkers in Patients with Neovascular Age-related Macular Degeneration

ABSTRACT Purpose: To investigate the effects of intravitreal ranibizumab (IVR) and intravitreal aflibercept (IVA) on systemic inflammatory and cardiovascular biomarkers in treatment-naive patients with neovascular age-related macular degeneration (nAMD) Methods: This study included 24 eyes of 24 patients treated with 0.5 mg ranibizumab (IVR group) and 25 eyes of 25 patients treated with 2.0 mg aflibercept (IVA group). Complete blood count, C-reactive protein (CRP), low-density lipoprotein cholesterol (LDL-c), high-density lipoprotein cholesterol (HDL-c), uric acid (UA), albumin, fibrinogen levels were measured in blood samples before and after the three-monthly loading dose treatment. Neutrophil/lymphocyte ratio (NLR), monocyte/HDL-c ratio (MHR), CRP/albumin ratio (CAR), monocyte/lymphocyte ratio (MLR), platelet/lymphocyte ratio (PLR) were also calculated. Results: A statistically significant decline was determined in post-treatment CRP (P = .002), LDL-c (P < .001) levels, white blood cell (WBC, P = .001), neutrophil (P < .001), monocyte (P = .019) counts and NLR (P = .020), MHR (P = .042), CAR (P = .010) ratios comparing with pre-treatment values in the IVA group. No statistically significant change was found in any of the parameters evaluated in the study in the IVR group. Also, there was no significant change in fibrinogen, lymphocyte count, MLR, HDL-c, UA, PLR, and platelet count values in both groups. Conclusion: Compared to IVR, IVA treatment had a small but significant effect on systemic inflammatory and cardiovascular biomarkers.

Comparison of 2-Year Outcomes between Intravitreal Ranibizumab and Intravitreal Aflibercept for Diabetic Macular Edema with "Treat-and-Extend" Regimen-Its Usefulness and Problems.

Background: To compare the effectiveness of intravitreal ranibizumab (IVR) and intravitreal aflibercept (IVA) performed with the treat-and-extend (TAE) regimen on eyes with diabetic macular edema (DME). Patients and methods: This is a retrospective study of 125 eyes of 125 treatment-naïve DME patients who received anti-VEGF injections at three consecutive monthly intervals as the loading phase. The changes in the best-corrected visual acuity (BCVA), central retinal thickness (CRT), diabetic retinopathy severity scale (DRSS), and total injection numbers were compared between the two anti-VEGF agents. Results: Among 125 eyes, 26 eyes completed the treatment with the TAE regimen for 24 months (20.8%). Thirteen eyes of 13 patients (mean age, 70.9 ± 6.0 years) received intravitreal injections of 0.5 mg ranibizumab, and 13 eyes of 13 patients (65.9 ± 8.6 years) received 2 mg aflibercept. No significant differences were detected in the baseline demographics. At 24 months, BCVA was significantly improved in both groups; from 0.31 ± 0.19 to 0.10 ± 0.12 logMAR units for IVR and 0.41 ± 0.19 to 0.16 ± 0.28 logMAR units for IVA (p = 1.29 × 10−9). CRT was significantly reduced in both groups; 440.9 ± 69.3 to 307.5 ± 66.4 μm for IVR and 473.9 ± 71.5 to 317.8 ± 71.2 μm for IVA (p = 3.55 × 10−9). No significant differences were detected in the improvements of BCVA, CRT in both groups, and the total injection numbers for 24 months (11.0 ± 1.2 for the IVA group and 12.0 ± 1.0 the IVR group). DRSS was significantly improved in both groups (p = 0.0004 for IVR and p = 0.009 for IVA). Conclusion: No significant differences were detected in the improvements of BCVA or CRT and injection numbers between the IVR and IVA groups treated with the TAE regimen. These results indicate that the results of the treatment with both agents with the TAE regimen were equally effective, but only 20.8% of patients completed 24 months of continuous treatment with the TAE regimen. Synopsis: There are no significant differences regarding effectiveness between the IVR and IVA groups treated with the TAE regimen for DME eyes.