Intravitreal Aflibercept Therapy in Intravitreal Bevacizumab/Ranibizumab Treatment-resistant Exudative Age-related Macular Degeneration

Abstract

INTRODUCTION: The objective of the study was to evaluate the functional and anatomical results of intravitreal aflibercept (IVA) in cases resistant to intravitreal bevacizumab (IVB)/ intravitreal ranibizumab (IVR) for exudative age-related macular degeneration (AMD). METHODS: Patients who did not have an increase in best-corrected visual acuity (BCVA) or intraretinal fluid (IRF)/ subretinal fluid (SRF) fluid regression despite at least three doses of IVB/IVR. The files of the patients were scanned and central macular thickness (CMT), presence of IRF/SRF, and height of pigment epithelial detachment (PED) were recorded before IVA, after 3 months of loading IVA, and 1 year after IVA and compared. RESULTS: A total of 31 patients with a mean age of 74.2+-10.53 were included in the study. The mean BCVA, CMT, and PED heights before IVA were 0.52+-0.31 LogMAR, 301.10+-76.27 µm, and 130.81+-73.72 µm, respectively. After three doses of IVA loading, mean BCVA, CMT, and PED heights were 0.51+-0.28 LogMAR, 262.86+-69.74 µm, and 96.00+-57.66 µm, respectively. A significant decrease was found in CMT and PED height values compared to the results obtained before IVA (p=0.001 and p=0.006). In the 1- year of IVA, mean BCVA, CMT, and PED heights were 0.53+-0.33 LogMAR, 257.61+-92.05 µm and 95.61+-66.67 µm, respectively. There was a significant decrease in CMT and PED values compared to the values obtained before IVA treatment (p=0.004 and p=0.04). DISCUSSION AND CONCLUSION: In exudative AMD patients resistant to IVB/IVR treatment, improvement in anatomical results is observed in the short and long term, while functional success is not affected by switch therapy.

Keywords

• aflibercept
• age-related macular degeneration
• bevacizumab
• ranibizumab.