Short-term outcomes of switching anti-VEGF agents in eyes with treatment-resistant wet AMD

Abstract

BackgroundTo investigate the short-term outcomes of treatment with intravitreal aflibercept in cases with wet age-related macular degeneration (AMD) resistant to ranibizumab.MethodsThe study included patients who had been undergoing follow-up for a minimum of three months at the Ankara University Faculty of Medicine Ophthalmology Department’s Retina Unit with a diagnosis of wet AMD. All cases had received intravitreal aflibercept injection due to the presence of intraretinal/subretinal fluid and pigment epithelial detachment (PED), as detected by optical coherence tomography (OCT), despite having received intravitreal ranibizumab. Medical records of the cases were investigated retrospectively and the demographic data, treatments administered before aflibercept injection, best-corrected visual acuity (BCVA) before and after aflibercept injection, central macular thickness (CMT), and the presence of intraretinal/subretinal fluid and the height and presence of PED were recorded.ResultsA total of 29 eyes from 11 females and 17 males were included in the study. The mean age was 73.89 ± 7.49 (62–92). The average number of intraocular injections administered before aflibercept injection was 11.75 ± 5.73 (6–25). The mean duration of follow-up following aflibercept injection was 4.55 ± 2.14 (3–11) months, with a mean of 3.44 ± 0.73 (3–5) aflibercept injections during this period. The mean BCVA values before and after aflibercept injection were found to be 0.83 and 0.77 LogMAR, respectively. The mean CMT values before and after aflibercept injection were 471.3 (97–1365) and 345.1 (97–585) microns, respectively (p < 0.001). The PED height before and after aflibercept injection was 350.4 ± 151.7 (129–793) and 255.52 ± 156.8 (0–528) microns, respectively (p < 0.05).ConclusionSwitching to intravitreal aflibercept appears to be an effective treatment modality for patients with AMD who are resistant to ranibizumab. While anatomic success including the effect of reducing the PED height was achieved in the short term following aflibercept injection in all cases, no concomitant increase in visual acuity occurred. This is attributed to the long-term presence of chronic fluid and the development of scar tissue before the treatment.

Comparison of the therapy effect of aflibercept and ranibizumab in patients with neovascular retinal pigment epithelium detachment identified by fluorescence angiography and optical coherence tomography angiography

“…We further analysed patients unresponsive to ranibizumab with a therapy switch to aflibercept. In accordance to the literature (26)(27)(28)(29)(30)(31), our results show a benefit of a therapy switch to aflibercept for patients' refractory to ranibizumab. Only one study showed visual acuity improvement after aflibercept injection according to a fixed regimen (28).…”

Aflibercept vs. Ranibizumab – funktionelle und morphologische Ergebnisse bei mit Ranibizumab vorbehandelter, chronisch-rezidivierender neovaskulärer altersabhängiger Makuladegeneration

“…Bei einer fortgeschrittenen nAMD ist möglicherweise aufgrund von strukturellen Umbauvorgängen wie Vernarbungen und Atrophien in der Makula ein schlechteres Ansprechen auf intravitreale Injektionen zu erwarten. Bisherige Studien zeigten bei langer Erkrankungsdauer insbesondere im Visus weniger Möglichkeit zur funktionellen Verbesserung gegenüber einer neu aufgetretenen AMD [8]. Ähnliches ist für das Anspre-…”

A Decade of Anti-VEGF Drugs in Ophthalmology- Successes and Challenges

“…In the SEVEN-UP study reporting the 7-year outcomes of patients with wet AMD receiving ranibizumab treatment, a considerable amount of patients had lost the visual gains made in the first years of treatment at the end of the 7th year [28]. Whether this relates to the natural course of the disease or to the occurrence of tachyphylaxis or tolerance to treatment associated with long-term intravitreal drug use is not yet fully understood [29][30][31].…”