APR 30, 2014
By Rahul Khurana, MD
Retina/Vitreous
This prospective study found that intravitreal aflibercept improved visual and anatomic outcomes in wet AMD patients resistant to anti-VEGF therapy.
Subjects included 49 wet AMD patients who still had intra- or sub-retinal fluid after at least four injections of ranibizumab within the past six months. They were switched to intravitreal aflibercept (Eylea; Regeneron). After three loading doses (2 mg each) administered every four weeks, aflibercept injections were given every eight weeks over a 24-week period.
At week 24, BCVA was improved significantly (mean, 6.9 letters) and central retinal thickness was reduced significantly (mean, 89.4 μm) compared with baseline (P < 0.001). Spacing of injections from every four to every eight weeks resulted in an increase of 37.4 μm in central retinal thickness (P < 0.001); however, this was not correlated with a significant change in vision. One patient lost more than five ETDRS letters and 27 (55 percent) gained more than five letters. Two patients had a more than 150 μm increase in central retinal thickness, and 10 showed a decrease in central retinal thickness of more than 150 μm.
The authors conclude that aflibercept therapy in this difficult-to-manage patient subgroup achieves improved vision and central retinal thickness with less frequent injections, thereby reducing the burden monthly treatment places on both patients and their treating physicians. Longer-term follow-up is required to further assess the efficacy in this setting.