Response to Aflibercept After Frequent Re-treatment With Bevacizumab or Ranibizumab in Eyes With Neovascular AMD

Abstract

BACKGROUND and OBJECTIVE: To evaluate the effects of switching to aflibercept in eyes with neovascular age-related macular degeneration (AMD) requiring frequent re-treatment with bevacizumab or ranibizumab.PATIENTS and METHODS: Retrospective review of 73 eyes of 65 patients with neovascular AMD switched to aflibercept due to persistent or recurrent macular fluid after at least 1 year of intravitreal bevacizumab or ranibizumab with re-treatment at least every 6 weeks. Minimum post-switch follow-up was 6 months. All patients were treated using a treat-and-extend strategy. the treatment intervals immediately after and before the switch were the same.RESULTS: the mean pre-switch anti-VEGF therapy duration was 45 months, and the mean number of injections was 31. in the 6 months after the switch, the average number of injections was reduced by 0.6 compared with the 6 months before the switch (P < .001). Visual acuity was unchanged during this period (P = .78). Central retinal thickness (CRT) decreased by 19 mu m after the switch (P < .001). Seventy eyes had vascularized retinal pigment epithelial detachments (PEDs). the decrease in the PED cube-root volume during the 6 months after the switch was statistically significant (-0.07 mm; P = .007).CONCLUSION: the number of injections, CRT, and PED volume decreased significantly after the switch to aflibercept, but visual acuity was unchanged.