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VISUAL AND ANATOMICAL OUTCOMES OF INTRAVITREAL AFLIBERCEPT IN EYES WITH PERSISTENT SUBFOVEAL FLUID DESPITE PREVIOUS TREATMENTS WITH RANIBIZUMAB IN PATIENTS WITH NEOVASCULAR AGE-RELATED MACULAR DEGENERATION

Kumar, Nishant FRCOphth*,†; Marsiglia, Marcela MD, PhD*,‡,§; Mrejen, Sarah MD*; Fung, Adrian Tien-chin MBBS, MMed*; Slakter, Jason MD*,‡; Sorenson, John MD*,‡; Freund, K. Bailey MD*,‡,§

doi: 10.1097/IAE.0b013e31828e8551
Original Study

Purpose: 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 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 after 6 months of treatment. Main outcome measures included change in visual acuity, central foveal thickness, and the height and diameter of the pigment epithelial detachment on the subfoveal scan on optical coherence tomography.

Results: Thirty-four eyes of 33 patients were analyzed. Mean duration of symptoms and average number of previous injections with anti–vascular endothelial growth factor agents was 44.7 ± 29.8 months (interquartile range [IQR] 24–76 months) and 28.6 ± 20.1 (IQR 10–47), respectively. At the 6-month follow-up, mean visual acuity and central foveal thickness improved significantly from 20/75 (logarithm of minimum angle of resolution 0.57 ± 0.36; IQR 0.30–1.0) and 416 ± 217 μm (IQR 263–487 μm) at baseline to 20/60 (logarithm of minimum angle of resolution 0.47 ± 0.32; IQR 0.30–0.60) (P = 0.004) and 248 ± 171 μm (IQR 235–419 μm) (P < 0.001), respectively. Maximum pigment epithelial detachment height improved significantly from 260 ± 162 μm (IQR 129–368 μm) to 214 ± 142 μm (IQR 111–305 μm) (P < 0.001) and PED diameter decreased significantly from 3,265 ± 1,622 μm (IQR 2,353–4,555 μm) to 2,949 ± 1,653 μm (IQR 1,721–4,484 μm) (P = 0.04).

Conclusion: Intravitreal injections of aflibercept resulted in a significant improvement in visual and anatomical outcomes in eyes with persistent subfoveal fluid despite previous treatment with ranibizumab.

Despite treatment with ranibizumab, a substantial number of eyes with neovascular age-related macular degeneration continue to have persistent fluid on optical coherence tomography. This study assesses the efficacy of intravitreal aflibercept in patients with persistent subfoveal fluid despite previous treatment with ranibizumab.

*Vitreous, Retina, Macula, Consultants of New York and the LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Institute, New York, New York;

Moorfields Eye Hospital, London, United Kingdom;

Department of Ophthalmology, New York University School of Medicine, New York, New York; and

§Department of Ophthalmology, Columbia University, New York, New York.

Reprint requests: K. Bailey Freund, MD, Vitreous, Retina, Macula Consultants of New York, 460 Park Avenue, 5th Floor, New York 10022, NY; e-mail: kbfnyf@aol.com

Supported by The Macula Foundation, Inc.

J. Slakter received research support from Genentech, Regeneron, and Novartis; K. B. Freund is an advisor and provided research support to Genentechand, Regeneron, and ThromboGenics. The other authors did not report any conflicts of interest.

N. Kumar and M. Marsiglia contributed equally to this work.

© 2013 by Ophthalmic Communications Society, Inc.