Rapid response of retinal pigment epithelial detachments to intravitreal aflibercept in neovascular age-related macular degeneration refractory to bevacizumab and ranibizumab

Patel, Kunal; Chow, Clement C.; Rathod, Rajiv; Mieler, William F.; Lim, Jennifer I.; Ulanski, Lawrence; Leiderman, Yannek I.; Arun, V.; Chau, Felix Y.

doi:10.1038/eye.2013.31

Cited by 89 publications

(61 citation statements)

References 13 publications

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“…Our study, which was carried out in routine daily practice, confirms optimal vision gains and anatomic disease control previously reported in two large clinical trials involving more than 2,400 patients with nvAMD [25] as well as in the 96-week extension of these trials [26]. Also, a number of observational studies have shown the beneficial effect of aflibercept therapy for nvAMD in both resistant to other VEGF inhibitors (bevacizumab and ranibizumab) [27,28,29,31,32] and as first line in clinical practice [33,34]. …”

Section: Discussionsupporting

confidence: 58%

Aflibercept as First-Line Therapy in Patients with Treatment-Naïve Neovascular Age-Related Macular Degeneration: Prospective Case Series Analysis in Real-Life Clinical Practice

et al. 2016

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Purpose: To assess the 13-month effectiveness and safety of aflibercept in naïve patients with neovascular age-related macular degeneration (nvAMD) in a real-life clinical setting. Methods: Thirty-two treatment-naïve patients with nvAMD participated in a prospective two-center study. Patients received intravitreal injections of aflibercept (Eylea®), a loading dose of three monthly injections (2 mg/0.05 ml) every 4 weeks for the first 3 months, followed by intravitreal injections every 2 months. Results: At 3 and 13 months, the mean best-corrected visual acuity improved significantly as compared with baseline (logMAR 0.53 ± 0.30 and 0.55 ± 0.32 vs. 0.30 ± 0.24, respectively, p < 0.001). At 3 and 13 months, 46.8% of patients (15/32) gained ≥15 ETDRS letters. The mean decrease in central macular thickness was also significant at 3 months (252 ± 35 µm) and at 13 months (249 ± 38 µm) as compared with pretreatment values (383 ± 76 µm) (p < 0.01). Also, 50% resolution of pigment epithelial detachment (PED) was observed in 8 out of 9 eyes (88.9%) with PED at baseline. Intravitreal injections were well tolerated and no adverse events were recorded. Conclusion: Aflibercept was effective and safe for treating nvAMD in naïve patients in routine daily practice.

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Section: Discussionsupporting

confidence: 58%

Aflibercept as First-Line Therapy in Patients with Treatment-Naïve Neovascular Age-Related Macular Degeneration: Prospective Case Series Analysis in Real-Life Clinical Practice

et al. 2016

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“…[4][5][6][7][8][9] Potential explanations for the overall anatomic success of aflibercept therapy in recalcitrant eyes include tachyphylaxis, pharmacogenetics, or the increased binding affinity of aflibercept.…”

Section: Discussionmentioning

confidence: 99%

Visual and anatomical outcomes following intravitreal aflibercept in eyes with recalcitrant neovascular age-related macular degeneration: 12-month results

Grewal

Gill

Sarezky

et al. 2014

Eye

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Purpose To describe the efficacy of intravitreal aflibercept on 12-month visual and anatomical outcomes in patients with neovascular age-related macular degeneration (AMD) recalcitrant to prior monthly intravitreal bevacizumab or ranibizumab. Methods Non-comparative case series of 21 eyes of 21 AMD patients with evidence of persistent exudation (intraretinal fluid/cysts, or subretinal fluid (SRF), or both) on spectral domain OCT despite Z6 prior intravitreal 0.5 mg ranibizumab or 1.25 mg bevacizumab (mean 29.8±17.1 injections) over 31.6±17.4 months who were transitioned to aflibercept. Results At baseline, best-corrected visual acuity (BCVA) was 0.42 ± 0.28 logarithm of minimum-angle of resolution (logMAR), central foveal thickness (CFT) was 329.38 ± 102.67 mm and macular volume (MV) was 7.71±1.32 mm 3 . After 12 months of aflibercept (mean 10.2±1.2 injections), BCVA was 0.40±0.28 logMAR (P ¼ 0.5), CFT decreased to 292.71 ± 91.35 mm (P ¼ 0.038) and MV improved to 7.33 ± 1.27 mm 3 (P ¼ 0.003). In a subset of 15 eyes with a persistent fibrovascular or serous pigment epithelial detachment (PED), mean baseline PED greatest basal diameter (GBD) was 2350.9±1067.6 mm and mean maximal height (MH) was 288.7±175.9 mm. At 12 months, GBD improved to 1896.3 ± 782.3 mm (P ¼ 0.028), while MH decreased to 248.27 ± 146.2 mm (P ¼ 0.002). ConclusionIn patients with recalcitrant AMD, aflibercept led to anatomic improvement at 12 months, reduction in proportion of eyes with SRF and reduction in PED, while preserving visual acuity.

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“…Moreover, although the drug reduced PED height, with morphological improvement, visual stability and macular sensitivity (measured by microperimetry after one year in a small sample of cases) were not maintained (19) . The intravitreal administration of the VEGF-A inhibitor aflibercept (Eylea®, Bayer) was effective and produced a quick response in three cases of elevated PED associated with neovascular AMD, despite the previous unsuccessful treatment with two other anti-angiogenic drugs (20) . Some studies have shown positive results with the regular use of low-fluence photodynamic therapy with verteporfin (Visudyne®, Valiant); however, these studies used a small sample size.…”

Section: Discussionmentioning

confidence: 99%

Grid laser photocoagulation in the treatment of serous avascular pigment epithelial detachment in age-related macular degeneration

Filho¹,

Moreira²,

Malafaia³

et al. 2014

Arquivos Brasileiros De Oftalmologia

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Purpose: Describe the outcomes of thermal laser photocoagulation in three cases of retinal pigment epithelium detachment associated to age-related macular degeneration. Methods: Three patients with avascular retinal pigment epithelium detachment were treated with green diode laser photocoagulation. Mild macular grid laser application, similar to the treatment of diabetic macular edema was performed after an unsuccessful intravitreal anti-angiogenic treatment. Results: After one year of the laser treatment, two cases reached anatomic resolution, with complete absorption of sub-epithelium serum fluid and improvement of the visual acuity. There was stability of the visual acuity and sub-epithelium fluid reduction, which, however, was partial in the third case. No complications related to the treatment occurred until the conclusion of this study. Conclusions: Macular photocoagulation in grid pattern produced regression of avascular serous pigment epithelium detachment associated with age-related macular degeneration in a short follow-up period. Although long term prospecti ve studies with an increased sample are necessary, it is a method that can be applied in selected patients, with absence of sub-retinal neovascularization or sub-epithelium fibrovascular component.

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Rapid response of retinal pigment epithelial detachments to intravitreal aflibercept in neovascular age-related macular degeneration refractory to bevacizumab and ranibizumab

Cited by 89 publications

References 13 publications

Aflibercept as First-Line Therapy in Patients with Treatment-Naïve Neovascular Age-Related Macular Degeneration: Prospective Case Series Analysis in Real-Life Clinical Practice

Aflibercept as First-Line Therapy in Patients with Treatment-Naïve Neovascular Age-Related Macular Degeneration: Prospective Case Series Analysis in Real-Life Clinical Practice

Visual and anatomical outcomes following intravitreal aflibercept in eyes with recalcitrant neovascular age-related macular degeneration: 12-month results

Grid laser photocoagulation in the treatment of serous avascular pigment epithelial detachment in age-related macular degeneration

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