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Indocyanine green angiography findings in patients with neovascular age-related macular degeneration refractory to ranibizumab switched to aflibercept

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Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusions

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.

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Authors and Affiliations

  1. Department of Ophthalmology, Hospital Universitario Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), c/Profesor Martin Lagos, 28040, Madrid, Spain

    Cristina Calvo-Gonzalez, Juan Reche-Frutos, José Ignacio Fernández-Vigo & Juan Donate-López

  2. Department of Preventive Medicine, Hospital Universitario Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain

    Irene Serrano-García & Cristina Fernández-Pérez

Authors
  1. Cristina Calvo-Gonzalez
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  2. Juan Reche-Frutos
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  3. José Ignacio Fernández-Vigo
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  4. Juan Donate-López
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  5. Irene Serrano-García
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  6. Cristina Fernández-Pérez
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Correspondence to Cristina Calvo-Gonzalez.

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Calvo-Gonzalez, C., Reche-Frutos, J., Fernández-Vigo, J.I. et al. Indocyanine green angiography findings in patients with neovascular age-related macular degeneration refractory to ranibizumab switched to aflibercept. Int Ophthalmol 39, 2441–2448 (2019). https://doi.org/10.1007/s10792-019-01082-z

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  • DOI: https://doi.org/10.1007/s10792-019-01082-z

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