Abstract

Purpose: To investigate the effect of switching patients with neovascular age related macular degeneration (nAMD) non-responsive to bevacizumab or ranibizumab to intravitreal aflibercept 2 mg on best corrected visual acuity, macula volume, and central macula thickness. Methods: 50 patients with nAMD non-responsive to bevacizumab or ranibizumab received 2 mg intravitreal aflibercept, at three 4-weekly doses, then every 8 weeks for 48 weeks. Primary outcome was BCVA at week 48 as measured on ETDRS charts. Secondary outcomes were proportion of patients with no fluid on OCT at week 12, 24 and 48; BCVA at week 12 and 24; mean changes in central macula thickness and macular volumes at week 12, 24 and 48; and tolerability and safety of aflibercept. Results: There was a trend towards an improvement of BCVA at week 48 compared to baseline (Student's t-test p = 0.056, Wilcoxon signed-ranked test p = 0.09901). There was a statistically significant improvement in central macula thickness (-99 μm, p < 0.001), macular volume (-0.75 mm3 p < 0.001) and PED height (-52.5 μm p < 0.001). 62% of these patients with previous recalcitrant disease had complete resolution subretinal fluid at the close of the study. Conclusion: Intravitreal aflibercept is a potentially viable treatment strategy for patients with recalcitrant neovascular AMD non-responsive to anti-VEGF monoclonal antibodies.

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