Efficacy and Safety of Aflibercept in Fibrovascular Retinal Pigment Epithelium Detachment refractory to prior ranibizumab therapy in neovascular Age-related macular degeneration (AMD).

摘要

Purpose : To report efficacy and safety of aflibercept in the treatment of neovascular AMD with associated retinal pigment epithelium detachment (PED) refractory to ranibizumab with at least 6 months of follow-up. Methods : This is a retrospective multicentric study including eyes with PED secondary to type 1 choroidal neovascularization (CNV) that had received at least 10 intravitreal injections of ranibizumab during the last 12 months. Exclusion criteria were: history of surgery within the last 3 months, previous thermal laser or photodynamic therapy, previous triamcinolone intravitreal injection, and any other active retinal disease. These eyes were treated with 3 loading dose of aflibercept (2mg/0.05ml) then followed every 4 weeks during 6 months. ETDRS visual acuity, slit lamp examination and SD-OCT were performed monthly, and eyes were treated as needed at the same visit. Results : Results of 46 eyes were analyzed. Mean age was 79.3?±9.2 years. Mean history duration of PED was 42 (1-59) months. Mean interval between the last intravitreal ranibizumab and the first aflibercept injection was 2?±1.2 months. Mean number of aflibercept injections was 5.7?± 1.2 during a mean follow-up of 35.6 weeks. Significant visual acuity improvement was observed at 12 weeks (+3.4 letters, p= 0.001) and at last visit (+2.7 letters, p 0.006). Height of PED decreased from baseline to 12 weeks (-33.8?μm, p=0.004) and at last visit (-36?μm, p = 0.005). No change was observed in central retinal thickness, macular volume and subfoveal choroidal thickness. Adverse events were found in 2 patients during the study duration. Conclusions : Visual acuity improved and PED height regressed significantly after switching to aflibercept in patients insufficiently responding to prior therapy with ranibizumab after 3 loading dose and retreatment as needed on a 4 weeks interval. Further study is required to elucidate maintain of visual and anatomic improvement in the long term. This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.