Indocyanine green angiography findings in patients with neovascular age-related macular degeneration refractory to ranibizumab switched to aflibercept
- 89 Downloads
To describe indocyanine green angiography (ICGA) and visual acuity (VA) results in patients with neovascular age-related macular degeneration (nAMD) refractory to ranibizumab switched to aflibercept.
This study is a prospective interventional case series. Thirty-two eyes of 32 patients with nAMD showing a poor response after at least 24 months of ranibizumab were switched to aflibercept. Twenty eyes had type I choroidal neovascularization (CNV group), and 12 eyes had polypoidal choroidal vasculopathy (PCV group). After an initial loading dose of three monthly aflibercept injections, treatment was continued on a treat-and-extend basis. ICGA was performed just before the first aflibercept injection (baseline) and 12 and 24 months later. The variables recorded were: closure of polyps and lesion area, VA, number of aflibercept injections, dry macula, and pigment epithelium detachment.
The following means were recorded in the CNV and PCV groups, respectively: number of ranibizumab injections 20.4 ± 11.2 and 22.4 ± 12.9 (p = 0.740); baseline VA (before aflibercept) 73.2 ± 9.1 and 70.3 ± 13.7 letters (p = 0.654); and final VA 73.0 ± 7.6 and 69.3 ± 15.6 letters (p = 0.509). VA remained stable (p = 0.761 and 0.964) after 15.5 ± 3 and 15.1 ± 3.5 aflibercept injections (p = 0.244). At 24 months, dry macula was noted in 40 to 50% of the eyes (p = 0.620). Complete resolution of polyps was observed in 58% at 12 months and 92% at 24 months.
In patients with nAMD refractory to ranibizumab, aflibercept was effective at maintaining VA and closing numerous polyps. In half of the patients, dry macula was observed at 24 months.
KeywordsIndocyanine green angiography Polypoidal choroidal vasculopathy Age-related macular degeneration Ranibizumab Poor responders Aflibercept
Compliance with ethical standards
Conflicts of interest
There are no known conflicts of interest by the authors associated with this publication.
- 9.Kawashima Y, Oishi A, Tsujikawa A, Yamashiro K, Miyake M, Ueda-Arakawa N, Yoshikawa M, Takahashi A, Yoshimura N (2015) Effects of aflibercept for ranibizumab-resistant neovascular age-related macular degeneration and polypoidal choroidal vasculopathy. Graefes Arch Clin Exp Ophthalmol 253:1471–1477CrossRefGoogle Scholar
- 10.Patel KH, Chow CC, Rathod R, MielerWF LJ, Ulanski LJ, Leiderman YI, Arun V, Chau FY (2013) Rapid response of retinal pigment epithelial detachments to intravitreal aflibercept in neovascular age-related macular degeneration refractory to bevacizumab and ranibizumab. Eye (Lond) 27:663–667CrossRefGoogle Scholar
- 11.Kumar N, Marsiglia M, Mrejen S, Fung AT, Slakter J, Sorenson J, Freund KB (2013) Visual and anatomical outcomes of intravitreal aflibercept in eyes with persistent subfoveal fluid despite previous treatments with ranibizumab in patients with neovascular age-related macular degeneration. Retina 33:1605–1612CrossRefGoogle Scholar
- 12.Bakall B, Folk JC, Boldt HC, Sohn EH, Stone EM, Russell SR, Mahajan VB (2013) Aflibercept therapy for exudative age-related macular degeneration resistant to bevacizumab and ranibizumab. Am J Ophthalmol 156(15–22):e11Google Scholar
- 19.Koh A, Lee WK, Chen LJ, Chen SJ, Hashad Y, Kim H et al (2012) EVEREST study: efficacy and safety of verteporfin photodynamic therapy in combination with ranibizumab or alone versus ranibizumab monotherapy in patients with symptomatic macular polypoidal choroidal vasculopathy. Retina 32:1453–1464CrossRefGoogle Scholar
- 20.Wolff B, Vasseur V, Cahuzac A, Coscas F, Castelnovo L, Favard C, Michel G, Français C, Salomon L, Mauget-Faÿsse M (2018) Aflibercept treatment in polypoidal choroidal vasculopathy: results of a prospective study in a Caucasian population. Ophthalmologica 25:1–5Google Scholar
- 25.Ozkaya A, Alagoz C, Garip R, Alkin Z, Perente I, Yazici AT, Taskapili M (2016) The role of indocyanine green angiography imaging in further differential diagnosis of patients with nAMD who are morphologically poor responders to ranibizumab in a real-life setting. Eye (Lond) 30(7):958–965CrossRefGoogle Scholar
- 31.Medina-Baena M, Huertos-Carrillo MJ, Rodríguez L, García-Pulido JI, Cornejo-Castillo C, Calandria-Amiguetti JM (2018) One-year outcome of aflibercept and photodynamic therapy in a caucasian patient with polypoidal choroidal vasculopathy refractory to ranibizumab and photodynamic therapy. Case Rep Ophthalmol 9:172–178CrossRefGoogle Scholar
- 32.Hara C, Wakabayashi T, Toyama H, Fukushima Y, Sayanagi K, Sato S, Sakaguchi H, Nishida K (2018) Characteristics of patients with neovascular age-related macular degeneration who are non-responders to intravitreal aflibercept. Br J Ophthalmol 8:8–9. https://doi.org/10.1136/bjophthalmol-2018-312275 Google Scholar