Aflibercept Treatment for Neovascular Age-related Macular Degeneration and Polypoidal Choroidal Vasculopathy Refractory to Anti-vascular Endothelial Growth Factor

Abstract

Purpose: To report the results of switching treatment to vascular endothelial growth factor (VEGF) Trap-Eye (aflibercept) in neovascular age-related macular degeneration (AMD) and polypoidal choroidal vasculopathy (PCV) refractory to anti-VEGF (ranibizumab and bevacizumab).

Methods: This is a retrospective study involving 32 eyes from 29 patients; 18 were cases of neovascular AMD and 14 were cases of PCV. The best-corrected visual acuity (BCVA) and central macular thickness (CMT) of spectral-domain optical coherence tomography were evaluated.

Results: BCVA and CMT improved from 0.58 to 0.55 (p = 0.005) and from 404 to 321 µm (p < 0.001), respectively, after switching to aflibercept. The 14 eyes that received 6 or more aflibercept injections remained stable at 0.81 to 0.81 and 321 to 327 µm (p = 1.0, 0.29), respectively, after 3 aflibercept injections. The 10 eyes that received 3 or more bevacizumab injections after 3 or more aflibercept injections worsened, from 0.44 to 0.47 and from 332 to 346 µm (p = 0.06, 0.05), respectively. The results showed similar improvement of BCVA and CMT in neovascular AMD and PCV.

Conclusions: Aflibercept seems to be effective for improvement and maintenance of BCVA and CMT for neovascular AMD and PCV refractory to anti-VEGF. Switching from aflibercept back to bevacizumab treatment may not be a proper strategy.

Keywords: Aflibercept; Anti-vascular endothelial growth factor; Bevacizumab; Macular degeneration; Polypoidal choroidal vasculopathy.

Fig. 1. Changes in mean best-corrected visual acuity (logarithm of the minimal angle of resolution, logMAR) for all cases including on-going and switching-back cases during the entire follow-up period. 2.7 months was the time point after 3 initial loading injections of aflibercept in all cases. 4.2 months was the time point of 4 or more on-going treatment of aflibercept in 14 cases. 4.6 months was the time point of switching-back treatment of bevacizumab in 10 cases. Improvement of best-correct visual acuity from baseline of all cases was statistically significant, but not significant in on-going or switching-back treatment cases during the entire follow-up period. Best-correct visual acuity was stable in on-going cases (p = 1.0) but deteriorated in switching-back cases (p = 0.06). VA = visual acuity. ^*p < 0.05.

Fig. 2. Changes in mean central macular thickness (CMT) of all cases, on-going cases, and switching-back cases during the entire follow-up period. 4.2 months was the time point of 4 or more on-going treatments of aflibercept in 14 cases. 4.6 months was the time point of switching-back treatment of bevacizumab in 10 cases. Improvement of CMT from baseline in all cases, including on-going and switching-back cases, was statistically significant during the entire follow-up period. However, after switching back to bevacizumab, CMT increased (p = 0.05) during the switching-back period. In contrast, CMT remained stable in on-going 4 or more treatment cases of aflibercept (p = 0.29) during the treatment period. ^*p < 0.05.