Aflibercept for exudative AMD with persistent fluid on ranibizumab and/or bevacizumab

作者：Cho Hyung; Shah Chirag P; Weber Marissa; Heier Jeffrey S^*

来源：British Journal of Ophthalmology, 2013, 97(8): 1032-1035.

DOI：10.1136/bjophthalmol-2013-303344

• Retina
• Drugs
• Macula
• Neovascularisation
• Treatment Medical

Objective
To investigate the effect of aflibercept 2.0mg in cases resistant to ranibizumab 0.5mg and/or bevacizumab 1.25mg treatment.
Purpose
To evaluate the anatomic and visual effect of intravitreal aflibercept 2.0mg in cases of exudative age-related macular degeneration (AMD) with persistent fluid on optical coherence tomography (OCT) despite regular ranibizumab 0.5mg and/or bevacizumab 1.25mg treatment at 1 and 6months.
Methods
Retrospective review at Ophthalmic Consultants of Boston, Boston, Massachusetts, USA of exudative AMD cases with persistent fluid on regular ranibizumab 0.5mg and/or bevacizumab 1.25mg treatment switched to intravitreal aflibercept 2.0mg treatment and followed for 6months. Tabulated data included details of prior treatments, best available visual acuity, central subfoveal thickness on registered spectral domain OCT before and after aflibercept injection centred on the anatomic fovea and macular description before and after aflibercept injection.
Results
A total of 353 eyes with exudative AMD were switched to aflibercept during the study period. Of these, 28 eyes in 28 patients had persistent fluid after an average of 20 regular ranibizumab/bevacizumab injections (range 7-37). At 1month, 89% (25 eyes) showed anatomic improvement and 18% (five eyes) were dry after a single aflibercept injection. Central subfoveal thickness improved from 295 to 272 microns (p<0.001) after one aflibercept injection. After an average of 4.4 aflibercept injections (range 3-6) over 6months, the central subfoveal thickness remained improved (274 microns, p=0.008); 64% (18 eyes) showed anatomic improvement and a quarter of eyes (25%, seven eyes) were dry. Visual acuity did not improve at 1month (logarithm of minimum angle of resolution (logMAR) 0.54, Snellen 20/69, p=0.64) or 6months (logMAR 0.57, Snellen 20/76, p=0.49). Treatment was well tolerated with no adverse events reported.
Conclusions
A significant proportion of exudative AMD cases with persistent fluid on OCT despite regular ranibizumab 0.5mg and/or bevacizumab 1.25mg treatment respond anatomically to aflibercept 2.0mg. Visual acuity did not improve. Aflibercept may be beneficial anatomically in cases of exudative AMD treated with persistent fluid on ranibizumab and/or bevacizumab.

• 出版日期2013-8