Aflibercept in neovascular age related macular degeneration previously refractory to standard intravitreal therapy: An Irish perspective to compare against international trends

Abstract

Purpose To determine visual and anatomical outcomes of Age‐Related Macular Degeneration (ARMD) patients, in a tertiary centre, following conversion to Aflibercept having been refractory to previous treatment with Bevacizumab and/or Ranibizumab and to make international comparisons. Methods A retrospective chart review of patients with a diagnosis of neovascular AMD (nvAMD) undergoing Aflibercept intravitreal therapy for at least six months who had previous treatment with three consecutive Bevacizumab ± Ranibizumab injections prior to switch. Exclusion criteria included any other procedures affecting visual outcome performed within the treatment period. Outcomes measured included visual acuity (VA), central macular thickness (CMT) and injection frequency. Results Sixty eyes of 52 patients were included, 25 of which were male. Mean BCVA pre‐switch was 55 ± 15 letters and CMT was 285 μm ± 77. Eyes received a mean of 14 ± 8 prior Bevacizumab/Ranibizumab. The mean follow up post switch was 13.2 months (SD = 5.5). Mean BCVA improved by two letters at six months (SD = 6.6, p < 0.05), by four letters at 12 months (SD = 6, p < 0.01). The mean VA at 18 and 24 months was unchanged from baseline VA. The mean CMT decreased by 44 μm at six months (SD = 73.5, p < 0.0001), 48.4 μm at 12 months (SD = 88.1, p < 0.01), 48 μm at 18 months (SD = 22.39, p < 0.001). The mean number of injections in the six months pre‐switch was 2.8 (SD = 0.8), this increased to a mean of 4 injections (SD = 0.94) in first six months post switch then decreased to 2 injections (SD = 1) in each six month period thereafter (p = 0.002).There were no significant systemic or ocular adverse events. Conclusions Switching to Aflibercept in patients with treatment resistant AMD produces statistically significant improvements in visual and anatomical outcomes with eventual maintenance of visual acuity levels at one year post switch.