J Korean Ophthalmol Soc.  2017 Jan;58(1):62-68. 10.3341/jkos.2017.58.1.62.

Efficacy of Three Aflibercept Injections for Neovascular Age-related Macular Degeneration Showing Limited Response to Ranibizumab

• Kim KM
• Kim JH
• Chang YS
• Kim JW
• Kim CG
• Lee DW

• KMID: 2367843
• DOI: http://doi.org/10.3341/jkos.2017.58.1.62

Abstract

PURPOSE
To evaluate the efficacy of 3 bimonthly aflibercept injections for neovascular age-related macular degeneration (AMD) that showed limited response to 3 initial ranibizumab injections.
METHODS
Three bimonthly aflibercept injections were performed for 21 eyes with neovascular AMD that was refractory to 3 monthly ranibizumab injections. Best-corrected visual acuity (BCVA) and central retinal thickness (CRT) were measured at diagnosis, 1 month after 3 ranibizumab injections, and 1 month after 3 aflibercept injections, and these values were compared.
RESULTS
The mean logarithm of minimal angle of resolution (logMAR) BCVA at diagnosis, after ranibizumab therapy, and after aflibercept therapy was 0.62 ± 0.29, 0.73 ± 0.31, and 0.65 ± 0.28, respectively. The CRT at the aforementioned times was 427.0 ± 98.7 µm, 409.5 ± 78.7 µm, and 315.9 ± 98.2 µm, respectively. When compared with the value measured after ranibizumab therapy, CRT was significantly decreased after aflibercept therapy (p < 0.001), whereas there was no significant difference in BCVA (p = 0.092) between the two times. Improved BCVA was noted in 8 eyes (38.1%) after aflibercept therapy and BCVA was unchanged in 11 eyes (52.4%). Decreased CRT was noted in 18 eyes (85.7%) after aflibercept therapy.
CONCLUSIONS
Three bimonthly aflibercept injections were found to be useful in terms of improving or maintaining visual acuity, as well as reducing retinal thickness in neovascular AMD that showed limited response to 3 initial ranibizumab injections.

Keyword

Aflibercept; Age-related macular degeneration; Anti-vascular endothelial growth factor; Ranibizumab

MeSH Terms

Diagnosis
Macular Degeneration*
Ranibizumab*
Retinaldehyde
Visual Acuity
Ranibizumab
Retinaldehyde

Figure

• 

  Figure 1. Changes in best-corrected visual acuity (BCVA) at diagnosis, 1 month after 3 monthly intravitreal ranibizumab in-jections (After R), and 1 month after 3 bimonthly intravitreal aflibercept injections (After A) (n = 21). (A) A line-plot show-ing mean ± standard deviation values at each time point. Statistical analysis was performed using repeated-measures analysis of variances. (B) A bar-graphs showing distribution of eyes experienced different degrees of changes in visual acuity. * Comparison of visual acuity between at diagnosis and after ra-nibizumab therapy; † Comparison of visual acuity between after ranibizumab therapy and after aflibercept therapy.

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  Figure 2. Changes in central foveal thickness at diagnosis, 1 month after 3 monthly intravitreal ranibizumab injections (After R), and 1 month after 3 bimonthly intravitreal afli-bercept injections (After A) (n = 21). (A) A line-plot showing mean ± standard deviation values at each time point. Statistical analysis was performed using repeated-measures analysis of variances. (B) A bar-graphs showing distribution of eyes expe-rienced different degrees of changes in central foveal thickness. * Comparison of visual acuity between at diagnosis and after ra-nibizumab therapy; † Comparison of visual acuity between after ranibizumab therapy and after aflibercept therapy.

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  Figure 3. A representative case of neovascular age-related macular degeneration. Optical coherence tomography images taken at diagnosis (A), 1 month after 3 monthly intravitreal ra-nibizumab injections (B), and 1 month after 3 bimonthly intra-vitreal aflibercept injections (C). Subretinal fluid and pigment epithelial detachment did not responded to initial ranibizumab therapy. However, marked resolution of these pathologic le-sions was noted after additional aflibercept therapy.

Reference

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