Geoffrey K Broadhead, Thomas Hong,Wijeyanthy Wijeyakumar, Haitao Li,Timothy Schlub, Meidong Zhu, Andrew A Chang
To describe changes in retinal morphologyfollowing treatment with aflibercept for previouslyanti-vascular endothelial growth factor (VEGF)-resistant neovascular age-related macular degenera-tion (nAMD).
49 patients with persistent exudation sec-ondary to anti-VEGF therapy-resistant nAMD weretreated with 2 mg afliberept in a prospective clinicaltrial. Treatment was given as three loading dosesmonthly (month 0, 1 and 2) followed by further treat-ment every 2 months (months 4 and 6). Patientsunderwent monthly ophthalmic examination, includ-ing best-corrected visual acuity (BCVA) and spectral-domain optical coherence tomography (SD-OCT).SD-OCT was graded for the presence of intraretinalfluid (IRF), subretinal fluid (SRF) Change in fluidstatus and correlation of this with visual and anatomi-cal outcomes was analysed.
Aflibercept therapy increased the number ofIRF free patients from 19 at baseline to 31 at month6(p = 0.003). It also improved the number of SRF freepatients from 5 at baseline to 20 at month6(p < 0.001). Spacing of treatment frequency fromevery 4 to every 8 weeks did not affect the proportionof IRF-free patients (p = 0.18). The proportion of SRFfree patients decreased significantly when injectionfrequency was prolonged (p = 0.01). Resolution of SRFat month 6 was weakly correlated with visualimprovement (4.9 letter gain in BCVA for SRF free vsSRF group, p = 0.05).
Intravitreal aflibercept was effective ineliminating both IRF and SRF in patients with nAMDpreviously resistant to anti-VEGF therapy. SRF recurred when injection frequency was prolonged,however IRF was unchanged. Improvement in SRFstatus was correlated with improved visual outcomes.