The outcomes of aflibercept therapy in patients with age-related macular degeneration resistant to bevacizumab or ranibizumab

PURPOSE: This study was designed to assess the functional and anatomic outcomes of intravitreal aflibercept injection in patients with wet age-related macular degeneration (AMD) refractory to intravitreal bevacizumab or ranibizumab therapy. METHODS: This retrospective study included 43 eyes of 43 patients resistant to treatment with at least 6 injections of bevacizumab or ranibizumab. Persistent intraretinal and subretinal fluid (IRF and SRF) on optical coherence tomography (OCT), no improvement in best corrected visual acuity (BCVA), and a central macular thickness (CMT) increase of more than 100 μm due to SRF and/or IRF compared to baseline for at least 6 monthly intravitreal bevacizumab or ranibizumab injections were defined as resistant to bevacizumab/ranibizumab therapy. BCVA, intraocular pressure (IOP), CMT, maximum retinal thickness (MRT), and maximum pigment epithelial detachment (PED) height (MPEDH) were evaluated before and after aflibercept injections. RESULT: After initiating aflibercept treatment, the mean final BCVA logarithm of the minimum angle of resolution or recognition (logMAR) improved to 0.84 ± 0.59 which was statistically significant compared to baseline (1.14 ± 0.51), (P < 0.001). After aflibercept injection, statistically significant reduction was noted in mean CMT (402.6 ± 196.7 μm vs 264.2 ± 52.85 μm, P < 0.05), MRT (435.3 ± 195.2 μm vs 282.2 ± 31.8 μm, P < 0.05), and MPEDH (154.2 ± 86.0 μm vs 68.3 ± 70.6 μm, P < 0.05). There was no correlation between the total number of previous injections and the increase of BCVA (r = −0.10, P = 0.265). The decrease of mean IOP was statistically significant under aflibercept treatment (P < 0.001). CONCLUSIONS: The present study showed the efficacy of aflibercept treatment in eyes with persistent retinal or SRF under bevacizumab or ranibizumab therapy. A significant anatomical and functional improvement was noted.