Short-Term Outcomes of Switching to Ranibizumab in Polypoidal Choroidal Vasculopathy Resistant to Aflibercept Therapy

Purpose: To investigate the efficacy of aflibercept-bevacizumab alternate dosing (AD) in neovascular age-related macular degeneration (AMD) with a limited response to bimonthly aflibercept injections.Methods: This retrospective study included patients given aflibercept-bevacizumab AD to treat neovascular AMD with bevacizumab given every alternate month between bimonthly aflibercept injections when they had a limited response to bimonthly aflibercept alone. The best-corrected visual acuity (BCVA) and central retinal thickness (CRT) were compared before AD and after the last AD. The incidence of subretinal fluid (SRF) and intraretinal fluid (IRF) before and after AD was also examined.Results: The study included 18 patients. The mean period between the diagnosis and AD was 37.9 ± 18.8 months and a mean of 3.1 ± 2.2 ADs were performed. The BCVA improved significantly from 0.45 ± 0.28 before AD to 0.36 ± 0.23 after AD (p = 0.036). The CRT decreased significantly from 440.3 ± 122.9 μm before AD to 317.7 ± 103.5 after AD (p = 0.001). The SRF was present in 94.4% and IRF in 55.6% before AD and in 22.2% and 11.1%, respectively, after AD.Conclusions: Aflibercept–bevacizumab AD was effective at resolving SRF/IRF in neovascular AMD with a limited response to bimonthlyaflibercept injections and should be a useful treatment option.

Outcome of Aflibercept-Bevacizumab Alternate Dosing in Neovascular Age-related Macular Degeneration with Limited Response to Aflibercept

Shin¹,

Kim²

2022

Course of Neovascular Age-related Macular Degeneration that Showed Limited Response to Both Ranibizumab and Aflibercept

Yun¹,

Kim²,

Kim³

et al. 2023

Purpose: To evaluate the clinical course of neovascular age-related macular degeneration (nAMD) that has shown limited response to ranibizumab and aflibercept.Methods: This retrospective study included 14 eyes with nAMD that showed a limited response to initial treatment using ranibizumab and aflibercept. The changes in visual acuity (VA) during the follow-up period and the incidence and timing of VA deterioration to the level of 0.1 or worse were identified. In cases involving bevacizumab treatment, the follow-up duration and the proportion of patients maintaining a VA of 0.2 or better were identified.Results: During the mean 43.3 ± 33.2 months of follow-up, the VA deteriorated significantly from a mean logarithm of minimum angle of resolution (logMAR) of 0.42 ± 0.34 at diagnosis to 0.91 ± 0.68 at the final follow-up (p = 0.021). A logMAR of 0.3 or greater degree of VA deterioration was noted in six eyes (42.9%). Among the 13 eyes exhibiting a VA of 0.2 or better after the initial treatment, a deterioration to a VA of 0.1 or worse was noted in 6 eyes (46.2%) at a mean 29.7 ± 18.3 months. In eight eyes undergoing bevacizumab treatment, four eyes (50.0%) maintained 0.2 or better VA during the 51.4 ± 35.5 months of follow-up.Conclusions: The clinical course of patients with limited response to ranibizumab and aflibercept was generally unfavorable. However, a relatively long period was required for the deterioration in VA to reach 0.1 or worse. In addition, 0.2 or better VA was maintained in approximately half of the patients.

Efficacy of Injection Interval Shortening in Neovascular Age-related Macular Degeneration with Limited Response to Bimonthly Aflibercept

Kim¹,

Kim²

2023

Purpose: To investigate the effectiveness of shortening the injection interval to < 2 months in neovascular age-related macular degeneration (AMD) with limited response to bimonthly aflibercept injections.Methods: We performed a retrospective analysis of medical records for neovascular AMD patients who received aflibercept injections with < 2 month intervals (shortened injection) because of limited response to bimonthly injections. The best-corrected visual acuity (BCVA) and central retinal thickness (CRT) were compared before and after shortened injections. The incidence of complete resolution of retinal edema was also analyzed.Results: A total of 28 patients were included, with a mean duration between diagnosis and shortened injection of 43.0 ± 20.5 months. The interval of the first shortened injection was 5 weeks in 8 eyes and 6 weeks in 20 eyes. BCVA changed from mean logarithm of minimal angle of resolution of 0.37 ± 0.21 to 0.32 ± 0.20 after shortening (p = 0.075). The mean CRT reduced significantly from 389.3 ± 73.7 μm to 242.1 ± 91.9 μm after shortening (p < 0.001). Retinal fluids resolved completely in 11 (39.3%) eyes after a single shortened injection, and in 15 (53.6%) eyes after two or more shortened injections.Conclusions: Shortening the injection interval to < 2 months had good anatomical efficacy in neovascular AMD with limited response to bimonthly aflibercept injections. However, the efficacy for improvement in visual acuity was limited. Further studies are required to investigate the long-term outcomes.