Short-term effect of aflibercept on visual acuity and central macular thickness in patients not responding to ranibizumab and bevacizumab.

Purpose: To analyze the clinical outcome of treatment with aflibercept in patients not responding to ranibizumab and bevacizumab.

Methods: Retrospective review of 32 eyes from 30 consecutive patients with choroidal neovascularization (CNV) who showed no response to treatment with ranibizumab or bevacizumab and were switched to aflibercept. Visual acuity, central macular thickness (CMT) and presence or absence of intraretinal or subretinal fluid were analyzed before switching to aflibercept, after each of three uploading dose injections of aflibercept and 6, 8 and 10 weeks after the third aflibercept injection. All eyes had previous ranibizumab injections and the mean number of previous injections was 14.75 (± 7.38). Mean duration of previous anti-vascular endothelial growth factor (VEGF) treatment was 38 months (± 27.35 months).

Results: Mean visual acuity before switching to aflibercept was 0.40 ± 0.30 logMAR. After the third injection visual acuity was 0.3 ± 0.3 logMAR and 10 weeks after the third injection it was 0.50 ± 0.20 logMAR. No significant differences were seen during treatment and follow-up. The mean CMT was 394 ± 118 µm at baseline, at follow-up (first, second and third, group week 6, group week 8 and group week 10) it was 317 ± 108 µm, 301 ± 99 µm, 292 ± 83 µm, 270 ± 78 µm, 340 ± 146 µm and 377 ± 92 µm, respectively. Significant reductions in CMT were seen between the first and third follow-up injections and at group week 8. Of the patients 59.4 % were complete non-responders to aflibercept.

Conclusion: Aflibercept results in improvement in CMT in non-responders to ranibizumab and bevacizumab as long as therapy is given continuously and can therefore be an alternative therapy.