Functional and anatomic efficacy of a conversion to aflibercept in eyes with age-related macular degeneration after long-term ranibizumab treatment.

BACKGROUND

It was the aim of this retrospective study to analyse the functional and anatomic efficacy of a conversion from ranibizumab to aflibercept treatment in eyes with exsudative age-related macular degeneration (AMD) with recently unsatisfactory response to a ranibizumab treatment.

MATERIAL, PATIENTS AND METHODS: 40 eyes of 37 patients (age: 80.6±7.7 years [mean±1 standard deviation (SD)] were included. The average visual acuity (VA) was 0.56±0.33 logMAR [mean±standard error (SE)] at the time of the first aflibercept injection. The eyes had received a mean of 21.5±11.7 (mean±SD) injections of ranibizumab within 3.15±1.79 (mean±SD) years. Follow-up covered 6 months in all patients. Before and after treatment and conversion of treatment, a PRN regimen with monthly visual acuity and OCT examinations was applied.

RESULTS

After conversion to aflibercept the mean gain of VA was 0.45±1.26 lines at month 1 (mean±SE, p=0.04), 0.26±1.60 at months 3 (p=0.067), and 0.65±1.77 (p=0.03) at month 6. Total OCT central foveal point thickness decreased from 417±215 µm (mean±1 SD) before the first injection of aflibercept to 299±139 (p<0.001), 325±174 at month 3 (p<0.001), and 321±150 µm at month 6 (p<0.001). The average number of aflibercept injections was 4.0±1.1 (mean±SD). At the end of follow up 61% of eyes had gained ≥1 line, 22%≥2 lines, and 12%≥ 3 lines. 10% had lost ≥1 line, 5%≥2 lines, and 2%≥3 lines.

CONCLUSIONS

The results of this case series show that conversion from ranibizumab to aflibercept can significantly reduce retinal thickness and improve visual acuity in patients with age-related macular degeneration with increasingly unsatisfactory response to long-term ranibizumab treatment.