Evaluation of Aflibercept Treatment Responses in Eyes with Bevacizumab/Ranibizumab-resistant Wet Age-related Macular Degeneration

Abstract

Objectives:To evaluate anatomic and functional results after switching from intravitreal bevacizumab or ranibizumab treatment to aflibercept for wet (neovascular) age-related macular degeneration.Materials and Methods:This retrospective study included 22 eyes of 22 patients resistant to treatment with at least 6 injections of bevacizumab or ranibizumab. The first three injections had been applied monthly, the others pro re nata (PRN). Outcome measures were follow-up period, injection number, best corrected visual acuity (BCVA), central retinal thickness (CRT) and pigment epithelial detachment (PED) height. Dosing regimen of aflibercept was determined PRN. The patients were examined monthly. In all visits, BCVA and optical coherence tomography results were assessed together and injections were applied according to these findings. Patients with at least three months of follow-up were included in the study.Results:Twenty-two eyes of 22 patients treated with bevacizumab or ranibizumab were switched to aflibercept therapy. Seven patients had serous PED and 4 patients had fibrovascular PED. The mean follow-up periods for these groups were 20.59±6.76 months and 8.68±3.79 months, respectively. The mean injection numbers were 10.5±3.61 vs 4.54±1.56. Statistically significant reductions were noted in CRT (533.86±164.06 µm vs 412.04±143.86 µm, p<0.05). BCVA levels were almost equal before and after switching (0.18±0.17 vs 0.18±0.14). Serous and fibrovascular PED heights decreased suboptimally from 460±281.51 µm to 282.42±175.76 µm (p>0.05) for serous PEDs and 251.25±43.85 µm to 225.75±73.09 µm (p>0.05) for fibrovascular PEDs.Conclusion:Switching to aflibercept resulted in significant improvement in CRT, but not in BCVA or PED heights.

Anti-VEGF-Resistant Retinal Diseases: A Review of the Latest Treatment Options

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Non-infectious Intraocular Inflammation Following Intravitreal Anti-Vascular Endothelial Growth Factor Injection

“… 1 As more intravitreal injections are performed, the number of such side effects is also increasing. 1 , 2 Non-infectious IOI has been reported in response to all anti-vascular endothelial growth factor (anti-VEGF) drugs 1 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , triamcinolone 12 , 13 , and ocriplasmin. 14 It typically occurs within a few days after injection, manifesting with visual impairment and vitritis without conjunctival injection and substantial pain.…”

A Multicenter, Retrospective Study (RE-ENACT 2) on the Use of Razumab™ (World’s First Biosimilar Ranibizumab) in Wet Age-Related Macular Degeneration

“…The third most common cause of blindness (after cataract and glaucoma), age-related macular degeneration (AMD, 8.7% of all blindness), affects the macular region of elderly patients (over 60 years old) [1,2]. Wet AMD is characterized by neovascularization spreading to the subretinal pigment epithelium or subretinal space, and increased presence of intraretinal fluid (IRF) or subretinal fluid (SRF) [3][4][5][6]. AMD is classified as ''wet'' and ''dry'' types [2].…”