VISUAL AND ANATOMICAL OUTCOMES
OF INTRAVITREAL AFLIBERCEPT IN EYES
WITH PERSISTENT SUBFOVEAL FLUID
DESPITE PREVIOUS TREATMENTS WITH
RANIBIZUMAB IN PATIENTS WITH
NEOVASCULAR AGERELATED MACULAR
NISHANT KUMAR, FRCOPIITH - MARCELA MARSIGLIA, MD, PHD - SARAH MREJEN MD
ADRIAN TIEN-CHIN FUNG, MBBS, MMED, - JASON SLAKTER, MD - JOHN SORENSON, MD, - K. BAILEY FREUND, MD
Purpose: To assess the efficacy of intravitreal aflibercept (2.0 mg) in patients with
treatment-resistant neovascular age-related macular degeneration.
Methods: Retrospective analysis of eyes treated with aflibercept with persistent
subretinal and/or intraretinal fluid despite previous treatments with intravitreal ranibizumab
(0.5 mg). All patients were switched to intravitreal aflibercept (2.0 mg) and analyzed after 3
consecutive injections and after 6 months of treatment. Main outcome measures included
change in visual acuity, central fovea! thickness, and the height and diameter of the
pigment epithelial detachment on the subfoveal scan on optical coherence tomography.
Results: Thirty-four eyes of 33 patients were analyzed. Mean duration of symptoms and
average number of previous injections with anti-vascular endothelial growth factor agents
was 44.7 ::!::: 29.8 months (interquartile range [IQR] 24-76 months) and 28.6 :::I::: 20.1 (IQR 10 47),
respectively. At the 6-month follow-up, mean visual acuity and central fovea! thickness
improved significantly from 20/75 (logarithm of minimum angle of resolution 0.57 ::t::: 0.36;
IQR 0.30-1.0) and 416 ::t:: 217 mm (IQR 263-487 mm) at baseline to 20/60 (logarithm
of minimum angle of resolution 0.47 :::t::: 0.32; IQR 0.30-0.60) (P = 0.004) and 248 ::!::: 171 mm
(IQR 235419 mm) (P < 0.001), respectively. Maximum pigment epithelial detachment height
improved significantly from 260 ::t:: 162 mm (IQR 129-368 mm) to 214 ::!::; 142 mm (IQR 111-305
mm) (P < 0.001) and PED diameter decreased significantly from 3265 :t;: 1,622 mm (IQR
2,353 4,555 mm) to 2,949 ::!:: 1,653 mm (IQR 1,721 4,484 mm) (P = 0.04).
Conclusion: Intravitreal injections of aflibercept resulted in a significant improvement in
visual and anatomical outcomes in eyes with persistent subfoveal fluid despite previous
treatment with ranibizumab.
Multipllarge multicenter trials have confirmed the
tent fluid is common after therapy. In the Comparison