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 agerelated 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 mm 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 mm vs 264.2 ± 52.85 mm, P < 0.05), MRT (435.3 ± 195.2 mm vs 282.2 ± 31.8 mm, P < 0.05), and MPEDH (154.2 ± 86.0 mm vs 68.3 ± 70.6 mm, P < 0.05). There was no correlation between the total number of previous injections and the increase of BCVA (r ¼ 0.10, P ¼ 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.