J Korean Ophthalmol Soc.  2015 Sep;56(9):1359-1364. 10.3341/jkos.2015.56.9.1359.

Intravitreal Aflibercept for Neovascular Age-Related Macular Degeneration Resistant to Bevacizumab and Ranibizumab

  • 1Department of Ophthalmology, Chonbuk National University Medical School, Jeonju, Korea. alberts123@hanmail.net
  • 2Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea.


To evaluate outcomes of intravitreal aflibercept in cases resistant to bevacizumab and ranibizumab in neovascular age-related macular degeneration.
Twenty patients with neovascular age-related macular generation who were resistant to treatment with bevacizumab and ranibizumab were evaluated. After switching to aflibercept the best corrected visual acuity (BCVA) and central retinal thickness (CRT) were compared at baseline and at 1 month after injection. Additionally, changes in the intraretinal fluid, subretinal fluid and pigment epithelial detachment were evaluated.
The mean BCVA was 0.83 +/- 0.56 log MAR and the mean CRT was 294.20 +/- 12.99 microm before aflibercept treatment. After switching to aflibercept the mean BCVA was 0.86 +/- 0.61 log MAR with no statistical difference (p = 0.406) and the mean CRT was decreased to 232.45 +/- 12.05 microm (p = 0.011). After 1 month of aflibercept injections, a reduction of intraretinal fluid in 4 eyes (80%), reduction of subretinal fluid in 11 eyes (78.6%) and reduction of pigment epithelial detachment in 5 eyes (50%) were observed. Increases in fluid or new lesions were not observed.
Aflibercept injection appears beneficial in patients with neovascular age-related macular generation who are resistant to bavacizumab and ranibizumab treatment.


Aflibercept; Neovascular age-related macular degeneration; Treatment-resistant

MeSH Terms

Macular Degeneration*
Subretinal Fluid
Visual Acuity


  • Figure 1. Change in central retinal thickness from baseline to 1 month after intravitreal aflibercept injection who were re-sistant to treatment with bevacizumab and ranibizumab in neo-vascular age-related macular degeneration (Paired t-test, p = 0.011).

  • Figure 2. A patient treated with 10th intravitreal bevacizumab and 9th intravitreal ranibizumab injection. Optical coherence tomog-raphy (OCT) showed persistent intraretinal (IRF), subretinal fluid (SRF) and pigment epithelial detachment (PED) (A). 1 month af-ter the first intravitreal aflibercept injection, OCT shows complete absorption of IRF, SRF with decreased PED (B).

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