Clinical Ophthalmology (May 2016)
One-year outcome of intravitreal aflibercept injection for age-related macular degeneration resistant to ranibizumab: rapid morphologic recovery and subsequent visual improvement
Abstract
Toshiaki Hirakata,1,2,* Kaoru Fujinami,1,3,4,* Ken Watanabe,5 Mariko Sasaki,1,3,6 Toru Noda,1,5 Kunihiko Akiyama1,5 1Laboratory of Visual Physiology, Division for Vision Research, National Institute of Sensory Organs, National Hospital Organization, Tokyo Medical Center, Tokyo, Japan; 2Department of Ophthalmology, Juntendo University of Graduate School of Medicine, Tokyo, Japan; 3Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan; 4UCL Institute of Ophthalmology, London, UK; 5Department of Ophthalmology, National Hospital Organization, Tokyo Medical Center, Tokyo, Japan; 6Department of Ophthalmology, Tachikawa Hospital, Tachikawa, Tokyo, Japan *These authors contributed equally to this work Objective: To describe the 1-year efficacy of aflibercept in Japanese patients with age-related macular degeneration (AMD) who were resistant to ranibizumab treatment. Design: Retrospective case series. Participants: Fourteen consecutive eyes of 14 patients with AMD were enrolled who had no substantial response or developed resistance to intravitreal ranibizumab injections. Methods: All patients were subcategorized into one of two subtypes of AMD: seven patients with occult choroidal neovascularization (CNV) and seven with polypoidal choroidal vasculopathy (PCV). Serial intravitreal aflibercept (IVA) injections were administered. Comprehensive ophthalmic examinations, including optical coherence tomography, were conducted at baseline and at follow-up examinations at 1, 3, 6, and 12 months after the initial IVA injection. The best-corrected visual acuity converted to logarithm of the minimum angle of resolution (logMAR) and central macular thickness (CMT) at each follow-up visit were compared with the baseline values. The anatomic response was also assessed with absorption or reduction of fluid in the subretina or subretinal pigment epithelial space. Results: The logMAR best-corrected visual acuity improved significantly at 3, 6, and 12 months in the total cohort: at 3 and 6 months in patients with occult CNV and at 3 and 12 months in patients with PCV. The CMT decreased significantly at all follow-up visits in the total cohort as well as in both subtypes, except for the CMT at 6 months in PCV patients. The anatomic improvement was also demonstrated in all cases, and pigment epithelial detachments tended to be resolved more rapidly in patients with PCV than in patients with occult CNV. Conclusion: Conversion to IVA was effective in patients with AMD resistant to ranibizumab, showing rapid morphologic improvement. The logMAR visual acuity was raised significantly within 12 months, and the clinical course of visual acuity improvement may differ according to the AMD subtypes. Keywords: aflibercept, age-related macular degeneration, occult choroidal neovascularization, polypoidal choroidal vasculopathy, ranibizumab, resistance
