Dramatic Resolution of Choroidal Neovascular Abnormalities After Single Aflibercept Injection Following Years of Ranibizumab Use

摘要

Aflibercept (Eylea) is the most recent anti-vascular endothelial growth factor (anti-VEGF) product approved by the US Food and Drug Administration to treat choroidal neovasculariza-tion (CNV) secondary to age-related macular degeneration. Compared with the other anti-VEGF agents commonly used to treat CNV, bevacizumab (Avastin) and ranibizumab (Lucentis), aflibercept has a longer intra-vitreal half-life and a higher binding affinity to VEGF-A receptor. While this drug is capable of inhibiting both VEGF-A (all isoforms) and placental growth factor, it has not been shown to be superior to ranibizumab. However, aflibercept given every 4 weeks for 3 doses followed by administration every 8 weeks has been shown to have visual acuity outcomes equivalent to those from administration of ranibizumab every 4 weeks through 1 year, providing an opportunity to evaluate its use in persistent retinal thickening from CNV despite years of monthly ranibizumab treatments. We provide an example of one such case demonstrating dramatic improvement 1 month after switching from 5 years of ranibizumab use to the first dose of aflibercept.