Visual and anatomical outcomes following intravitreal aflibercept in eyes with recalcitrant neovascular age-related macular degeneration: 12-month results

Purpose To describe the efficacy of intravitreal aflibercept on 12-month visual and anatomical outcomes in patients with neovascular age-related macular degeneration (AMD) recalcitrant to prior monthly intravitreal bevacizumab or ranibizumab. Methods Non-comparative case series of 21 eyes of 21 AMD patients with evidence of persistent exudation (intraretinal fluid/cysts, or subretinal fluid (SRF), or both) on spectral domain OCT despite >= 6 prior intravitreal 0.5mg ranibizumab or 1.25mg bevacizumab (mean 29.8 +/- 17.1 injections) over 31.6 +/- 17.4 months who were transitioned to aflibercept. Results At baseline, best-corrected visual acuity (BCVA) was 0.42 +/- 0.28 logarithm of minimum-angle of resolution (logMAR), central foveal thickness (CFT) was 329.38 +/- 102.67 mu m and macular volume (MV) was 7.71 +/- 1.32 mm(3). After 12 months of aflibercept (mean 10.2 +/- 1.2 injections), BCVA was 0.40 +/- 0.28 logMAR (P = 0.5), CFT decreased to 292.71 +/- 91.35 mu m (P = 0.038) and MV improved to 7.33 +/- 1.27mm(3) (P = 0.003). In a subset of 15 eyes with a persistent fibrovascular or serous pigment epithelial detachment (PED), mean baseline PED greatest basal diameter (GBD) was 2350.9 +/- 1067.6 mu m and mean maximal height (MH) was 288.7 +/- 175.9 mu m. At 12 months, GBD improved to 1896.3 +/- 782.3 mu m (P = 0.028), while MH decreased to 248.27 +/- 146.2 mu m (P = 0.002). Conclusion In patients with recalcitrant AMD, aflibercept led to anatomic improvement at 12 months, reduction in proportion of eyes with SRF and reduction in PED, while preserving visual acuity.