Intravitreal aflibercept for polypoidal choroidal vasculopathy after developing ranibizumab tachyphylaxis

Abstract

Masahiro Miura,1,2 Takuya Iwasaki,1,2 Hiroshi Goto2 1Department of Ophthalmology, Tokyo Medical University, Ibaraki Medical Center, Ami, Ibaraki, Japan; 2Department of Ophthalmology, Tokyo Medical University, Nishi-Shinjuku, Tokyo, Japan Purpose: To evaluate the effect of aflibercept treatment after developing ranibizumab tachyphylaxis for the treatment of polypoidal choroidal vasculopathy (PCV). Patients and methods: Ten eyes from ten patients with PCV who developed ranibizumab tachyphylaxis were reviewed. Tachyphylaxis was defined as when repeated intravitreal ranibizumab (IVR) resulted in a complete lack of response after initial treatment response. All treatments were converted to intravitreal aflibercept (IVA) after development of ranibizumab tachyphylaxis. Central retinal thickness (CRT) was compared at baseline, at complete resolution after IVR, at reactivation after IVR, at initial IVA, and at 4 and 12 weeks after initial IVA. Results: Mean number of IVR treatments before conversion to IVA was 11.3 (range 5–16). All eyes had positive therapeutic responses after conversion to IVA. Mean CRT at 4 and 12 weeks after initial IVA was significantly decreased from baseline initial IVA (P = 0.005). Conclusion: Switching therapy to aflibercept is effective for patients with PCV who develop tachyphylaxis to ranibizumab. Keywords: polypoidal choroidal vasculopathy, ranibizumab, aflibercept, tachyphylaxis