Neovascular age-related macular degeneration: 18-month outcomes of aflibercept treatment in patients resistant to ranibizumab

Objectives: Aim of this study is to investigate the effect of intravitreal aflibercept therapy in an 18-monthperiod in patients with recurrent neovascular age-related macular degeneration resistant to intravitrealranibizumab.Methods: This is a prospective study of eyes with neovascular age-related macular degeneration switched tointravitreal aflibercept with at least 18 month of follow-up after the switch. All patients had had a minimum of6 injections of ranibizumab before the switch. All patients received a loading dose of three intravitreal 2 mgaflibercept injections at 4-week intervals. Changes in best-corrected visual acuity, central macular thicknessand the frequency of injections were compared.Results: The study included 39 patients, each with one diseased eye. The studied eyes had received an averageof 10.74 ± 4.38 previous intravitreal ranibizumab injections over a period of 28.31 ± 18.08 months. During thestudy, an average of 6.94 ± 2.58 intravitreal aflibercept injections were given in a period of 18 months. Meancentral macular thickness at baseline, before switching to aflibercept, 6, 12, and 18 months after the afliberceptinjection were 327.44 ± 120.57, 354.50 ± 127.79, 290.20 ± 112.25, 311.70 ± 119.47, and 299.29 ± 98.38 μm,respectively. A significant change was found in the macular thickness measured at intervals throughout thestudy. However, no significant improvement was found in visual acuity after 18 month after switching toaflibercept.Conclusions: Switching from intravitreal ranibizumab, an inhibitor of vascular endothelial growth factor-A,to aflibercept, another inhibitor for such factors, has increased central macular thickness significantly withoutchanges in visual acuity.

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