Purpose
To report results of aflibercept therapy in eyes with neovascular age-related macular degeneration previously treated with bevacizumab and/or ranibizumab.
Design
Retrospective, interventional, non-comparative, consecutive case series
Methods
Ninety-six eyes, 85 patients, with neovascular AMD that had previously received bevacizumab and/or ranibizumab were treated with aflibercept monthly for 3 months followed by a fourth injection within 2 months. Outcomes were determined 4 ± 1 months after the first aflibercept dose and included: proportion of patients gaining or losing ≥ 2 lines of best corrected visual acuity (BCVA), proportion remaining within ±1 line, mean change in logMAR VA, mean change in central foveal thickness, mean change in macular cube volume, and qualitative anatomic response as assessed by spectral-domain OCT.
Results
At baseline, 82 (85%) eyes had signs of active exudation despite a mean 17 previous anti-VEGF injections. At final visit, 82 (85%) remained stable within ±1 line, 7 (7%) gained and 7 (7%) lost ≥ 2 lines of BCVA. Mean logMAR VA showed minimal change 0.02 (range −0.46 to 0.70, P=0.14). Mean central foveal thickness decreased −18 microns (range −242 to 198, P=0.06). Mean macular volume decreased −0.27 mm3 (95% CI, −0.4 to −0.1, P = 0.004). On qualitative analysis, 4 (5%) eyes had complete resolution of exudative fluid, 40 (49%) partially resolved, 26 (32%) remained unchanged, and 12 (14%) worsened.
Conclusion
Aflibercept appears to be an effective alternative for neovascular AMD patients previously treated with bevacizumab and/or ranibizumab at 4 months follow-up. The majority of treated eyes demonstrated stable VA and anatomic improvements by SD-OCT.
This series represents the largest single-institution report on endogenous methicillin-resistant S. aureus endophthalmitis and associated outcomes. Although previously reported cases cited poor visual outcomes and high enucleation rates, the authors' current series shows that retinal detachments are common and enucleation rates are low.
High-resolution 7-T MRI with a dedicated eye coil can provide unique high-resolution noninvasive images of retro-orbital and posterior ocular structural and vascular anatomy and is able to resolve structures as small as the central retina vein.
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