Aflibercept Therapy for Exudative Age-related Macular Degeneration Resistant to Bevacizumab and Ranibizumab

• Published in: American journal of ophthalmology Vol. 156; no. 1; pp. 15 - 22.e1
• Main Authors: Bakall, Benjamin, Folk, James C, Boldt, H. Culver, Sohn, Elliott H, Stone, Edwin M, Russell, Stephen R, Mahajan, Vinit B
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.07.2013; Elsevier Limited
• Subjects: Aged; Aged, 80 and over; Angiogenesis Inhibitors - therapeutic use; Antibodies, Monoclonal, Humanized - therapeutic use; Bevacizumab; Clinical trials; Colleges & universities; Drug Resistance; Drug Substitution; Exudates and Transudates; Female; Health Insurance Portability & Accountability Act 1996-US; Human subjects; Humans; Intravitreal Injections; Macular degeneration; Male; Middle Aged; Ophthalmology; Postoperative Complications; Ranibizumab; Receptors, Vascular Endothelial Growth Factor - therapeutic use; Recombinant Fusion Proteins - therapeutic use; Retina - pathology; Retreatment; Retrospective Studies; Subretinal Fluid - metabolism; Tomography, Optical Coherence; Treatment Outcome; Vascular endothelial growth factor; Vascular Endothelial Growth Factor A - antagonists & inhibitors; Visual Acuity - physiology; Wet Macular Degeneration - diagnosis; Wet Macular Degeneration - drug therapy; Wet Macular Degeneration - physiopathology; California
• ISSN: 0002-9394; 1879-1891
• DOI: 10.1016/j.ajo.2013.02.017

Purpose To evaluate the outcome of intravitreal injection of aflibercept in cases with exudative age-related macular degeneration, (AMD) resistant to injections of bevacizumab or ranibizumab. Design Retrospective observational case series. Methods A retrospective chart review at a single institution was conducted to identify patients with exudative AMD and choroidal neovascularization (CNV) in 1 or both eyes resistant to treatment with ranibizumab or bevacizumab who were switched to treatment with at least 3 monthly injections of aflibercept. In total, 36 eyes from 31 patients were included. The demographic data, visual acuities, central macular thickness on optical coherence tomography (OCT), complications, and number of injections were reviewed. Results The mean patient age was 79 years (range 60-88). There were 13 male and 18 female patients. The number of prior injections with either bevacizumab or ranibizumab ranged from 6-74. After 3 monthly injections of aflibercept, there was a reduction of either subretinal or intraretinal fluid in 18 of 36 (50.0%) of the treated eyes; the amount of fluid remained stable in 15 eyes (41.7%) and worsened in 3 eyes (8.3%). A significant average decrease was observed for the central macular thickness after 3 injections of 65 μm ( P  = 2.9 × 10-6 ), with no significant change in visual acuity. Conclusions Aflibercept therapy appears to be beneficial in a subset of patients with neovascular age-related macular degeneration who exhibit recurrent or resistant intraretinal or subretinal fluid following multiple injections with either bevacizumab or ranibizumab.