Functional and Anatomic Efficacy of a Conversion to Aflibercept in Eyes with Age-Related Macular Degeneration after Long-Term Ranibizumab Treatment

 

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Abstract

Background: It was the aim of this retrospective study to analyse the functional and anatomic efficacy of a conversion from ranibizumab to aflibercept treatment in eyes with exsudative age-related macular degeneration (AMD) with recently unsatisfactory response to a ranibizumab treatment. Material, Patients and Methods: 40 eyes of 37 patients (age: 80.6 ± 7.7 years [mean ± 1 standard deviation (SD)] were included. The average visual acuity (VA) was 0.56 ± 0.33 logMAR [mean ± standard error (SE)] at the time of the first aflibercept injection. The eyes had received a mean of 21.5 ± 11.7 (mean ± SD) injections of ranibizumab within 3.15 ± 1.79 (mean ± SD) years. Follow-up covered 6 months in all patients. Before and after treatment and conversion of treatment, a PRN regimen with monthly visual acuity and OCT examinations was applied. Results: After conversion to aflibercept the mean gain of VA was 0.45 ± 1.26 lines at month 1 (mean ± SE, p = 0.04), 0.26 ± 1.60 at months 3 (p = 0.067), and 0.65 ± 1.77 (p = 0.03) at month 6. Total OCT central foveal point thickness decreased from 417 ± 215 µm (mean ± 1 SD) before the first injection of aflibercept to 299 ± 139 (p < 0.001), 325 ± 174 at month 3 (p < 0.001), and 321 ± 150 µm at month 6 (p < 0.001). The average number of aflibercept injections was 4.0 ± 1.1 (mean ± SD). At the end of follow up 61 % of eyes had gained ≥ 1 line, 22 % ≥ 2 lines, and 12 % ≥ 3 lines. 10 % had lost ≥ 1 line, 5 % ≥ 2 lines, and 2 % ≥ 3 lines. Conclusions: The results of this case series show that conversion from ranibizumab to aflibercept can significantly reduce retinal thickness and improve visual acuity in patients with age-related macular degeneration with increasingly unsatisfactory response to long-term ranibizumab treatment.

Zusammenfassung

Hintergrund: Ziel dieser retrospektiven Studie war es, die funktionelle und anatomische Effizienz eines Wechsels der Behandlung von Ranibzumab zu Aflibercept bei Patienten mit feuchter altersabhängiger Makuladegeneration und zuletzt nicht zufrieden stellendem Ansprechen nach Langzeittherapie durch Ranibizumab zu analysieren. Material, Patienten und Methoden: Eingeschlossen wurden 40 Augen von 37 Patienten [Alter: 80,6 ± 7,7 Jahre, Mittelwert (MW) ± 1 Standardabweichung (SD)]. Der durchschnittliche Visus betrug 0,56 ± 0,33 logMAR [MW ± Standardfehler (SE)] zum Zeitpunkt des Therapiewechsels. Im Mittel waren 21,5 ± 11,7 (MW ± SD) Lucentis-Injektionen über einen Zeitraum 3,15 ± 1,79 (MW ± SD) Jahre gegeben worden. Die Nachbeobachtung erstreckte sich über 6 Monate. Vor und nach dem Therapiewechsel wurden die Patienten nach einem PRN-Schema mit monatlichen Visus- und OCT-Kontrollen betreut. Ergebnisse: Nach Wechsel zu Aflibercept war nach 1 Monat ein Visusanstieg von 0,45 ± 1,26 Linien, (MW ± SE, p = 0,04), nach 3 Monaten von 0,26 ± 1,60 (p = 0,067) und nach 6 Monaten von 0,65 ± 1,77 (p = 0,03) festzustellen. Die totale zentrale foveal Netzhautdicke betrug vor dem Wechsel 417 ± 215 µm (MW ± SD), nach 1 Monat 299 ± 139 µm (p < 0,001), nach 3 Monaten 325 ± 174 µm (p < 0,001) und 321 ± 150 µm nach 6 Monaten (p < 0,001). Es wurden im Mittel 4,0 ± 1,1 Aflibercept-Injektionen (MW ± SD) appliziert. Zum Ende der Nachbeobachtungszeit hatten 61 % aller Augen ≥ 1 Zeile, 22 % ≥ 2 Zeilen und 12 % ≥ 3 Zeilen gewonnen. 10 % alle Augen hatten im gleichen Zeitraum ≥ 1 Zeile, 5 % ≥ 2 Zeilen und 2 % ≥ 3 Zeilen verloren. Schlussfolgerungen: Die Ergebnisse dieser Fallserie zeigen, dass bei Patienten nach Langzeittherapie mit Ranibzumab und nicht zufrieden stellendem Ansprechen der Therapie durch einen Wechsel zu Aflibercept eine signifikante Verminderung der zentralen Netzhautdicke und ein Visusanstieg erzielt werden kann.

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