One-Year Results of Aflibercept in Vascularized Pigment Epithelium Detachment due to Neovascular AMD: A Prospective Study

Abstract

Aflibercept appears to induce anatomical improvement for at least 12 months after conversion from ranibizumab in patients experiencing nAMD-related PED. Significant reductions in both mean PED height and CRT were observed, although these changes were not necessarily related to significantly improved visual acuity scores. However, larger patient cohorts are required to extend and validate our results, and increased study duration would allow exploration of the potential long-term benefits and challenges of prolonged aflibercept use.

Two-Year Outcome of Aflibercept in Patients with Pigment Epithelial Detachment due to Neovascular Age-Related Macular Degeneration (nAMD) Refractory to Ranibizumab

“…Significant improvement in DEP height at month 3 and month 6 in our study is consistent with previously published data showing that treatment with aflibercept led to significant anatomic improvements in patients with persistent exudation under other anti-VEGF [ 15 , 17 – 20 , 23 , 28 , 33 ]. Change of PED height was not found at 1 and 2 years, which might be explained by manual measurement of maximum height and absence of inferior limit of PED height in inclusion criteria in our study.…”

“…Various studies have examined the efficacy of aflibercept in patients with PED refractory of ranibizumab and/or bevacizumab treatment [ 17 , 18 , 20 , 23 , 33 – 35 ]. However, comparisons are difficult due to many differences: duration of anti-VEGF varied from 3 months to 12 months before switch, inclusion of vascularized PEDs [ 17 , 20 , 33 ] and/or serous PEDs; [ 15 ] visual acuity was expressed in ETDRS and logMAR; and PED improvement expressed in maximum height, volume [ 21 ], and diameter [ 20 ]. Mean follow-up varied from 3 months to 1 year.…”

“…Mean follow-up varied from 3 months to 1 year. In these reports, switching from ranibizumab to aflibercept result to unchanged visual acuity in some retrospective studies [ 15 , 18 , 26 , 28 ], whereas visual gain had been demonstrated at 6 months or 12 months end point in other prospective studies [ 17 , 19 , 35 ] or retrospective studies with short-term results at 3 months or 6 months [ 20 , 21 ]. Our study reports results at different time points from baseline to 2 years of aflibercept treatment for PEDs related to nAMD with persistent exudation despite monthly ranibizumab the year prior conversion.…”

“…The absence of significant changes in the central retinal thickness in our study is surprising. Reduction on CRT thickness varied from −19 μ m to −68 μ m after a six-month period of aflibercept therapy in published data [ 17 , 18 , 20 , 23 , 35 ]. These data may reflect variations in patient populations between studies or the fact that our study did not fully meet the power requirements to demonstrate a statistically significant difference.…”

“…Pharmacological studies have shown that aflibercept differs from bevacizumab and ranibizumab by its higher affinity and additionally inhibits placental growth factor (PIGF) [ 11 ]. These differences led to several studies on the advantages of switching from ranibizumab and/or bevacizumab to aflibercept in refractory nAMD cases and its potential for the treatment of PED-related nAMD [ 12 – 17 ]. With the exception of some studies [ 18 – 21 ], most studies showed anatomical [ 15 , 17 , 22 – 28 ] but usually no functional benefit.…”