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. 2018 Jun;38(6):1156-1165.
doi: 10.1097/IAE.0000000000001726.

HIGH-DOSE HIGH-FREQUENCY AFLIBERCEPT FOR RECALCITRANT NEOVASCULAR AGE-RELATED MACULAR DEGENERATION

Qi Sheng You  1   2 , Raouf Gaber  1 , Amit Meshi  1 , Hema L Ramkumar  1 , Mostafa Alam  1   3 , Ilkay Kilic Muftuoglu  1 , William R Freeman  1
Affiliations

HIGH-DOSE HIGH-FREQUENCY AFLIBERCEPT FOR RECALCITRANT NEOVASCULAR AGE-RELATED MACULAR DEGENERATION

Qi Sheng You et al. Retina. 2018 Jun.

Abstract

Purpose: To determine the efficacy of monthly (0.1 mL/4 mg) aflibercept for refractory neovascular age-related macular degeneration (wet age-related macular degeneration).

Methods: This was a retrospective interventional case series in which patients with wet age-related macular degeneration were treated with stepwise dose escalation. Nonvitrectomized patients resistant to monthly (Q4W) ranibizumab/bevacizumab were switched to 2 mg aflibercept every 8 weeks. With resistance, they were escalated to Q4W 2 mg aflibercept, then Q4W 4 mg (high dose high frequency, 4Q4W) aflibercept. Resistance was defined as ≥2 recurrences after being dry following ≥3 injections or persistent exudation on treatment of ≥5 injections.

Results: Thirty-three eyes of 28 patients were treated with 4Q4W aflibercept and followed for a mean of 16 months. A dry retina (no intraretinal or subretinal fluid) was achieved after initiating 4Q4W aflibercept treatment at a mean of 3.8 months. Central foveal thickness, maximum foveal thickness, intraretinal fluid, subretinal fluid, and retinal pigment detachment height decreased significantly at 1 month after initiating the 4Q4W aflibercept, and the morphologic therapeutic effect was sustained until the last visit. Forty-five percent of eyes had one or more lines of vision improvement. New geographic atrophy developed in 9% of eyes during follow-up. No ocular or systemic adverse events occurred after initiating 4Q4W aflibercept.

Conclusion: Intravitreal high-dose high-frequency aflibercept is an effective treatment for patients with refractory wet age-related macular degeneration.

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Conflict of interest statement

None of the authors has any financial/conflicting interests to disclose.

Figures

Fig. 1.
Fig. 1.
Central foveal thicknesses before and after initiating aflibercept 4 mg every 4-week treatment. CI, confidence interval.
Fig. 2.
Fig. 2.
Maximum foveal thicknesses before and after initiating aflibercept 4 mg every 4 weeks. CI, confidence interval.
Fig. 3.
Fig. 3.
Maximum IRF height before and after initiating aflibercept 4 mg every 4 weeks. CI, confidence interval.
Fig. 4.
Fig. 4.
Maximum SRF height before and after initiating aflibercept 4 mg every 4 weeks. CI, confidence interval.
Fig. 5.
Fig. 5.
Retinal pigment epithelial detachment height before and after initiating aflibercept 4 mg every 4 weeks. CI, confidence interval.
Fig. 6.
Fig. 6.
Kaplan–Meier curve of the survival time to get dry after initiating monthly 4 mg aflibercept intravitreal injections.
Fig. 7.
Fig. 7.
Mean visual acuity before and after initiating aflibercept 4 mg every 4 weeks. CI, confidence interval; logMAR, logarithm of the minimum angle of resolution.
See this image and copyright information in PMC

Comment in

  • Correspondence.
    Călugăru D, Călugăru M. Călugăru D, et al. Retina. 2017 Nov;37(11):e139-e141. doi: 10.1097/IAE.0000000000001886. Retina. 2017. PMID: 28984744 No abstract available.
  • Reply.
    You QS, Meshi A, Muftuoglu IK, Freeman WR. You QS, et al. Retina. 2017 Nov;37(11):e141-e143. doi: 10.1097/IAE.0000000000001887. Retina. 2017. PMID: 29065081 Free PMC article. No abstract available.

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