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

Abstract

PurposeTo 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.MethodsThis study is a prospective interventional case series. Thirty-two eyes of 32 patients with nAMD showing a poor response after at least 24\xa0months 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\xa0months later. The variables recorded were: closure of polyps and lesion area, VA, number of aflibercept injections, dry macula, and pigment epithelium detachment.ResultsThe following means were recorded in the CNV and PCV groups, respectively: number of ranibizumab injections 20.4\u2009±\u200911.2 and 22.4\u2009±\u200912.9 (p\u2009=\u20090.740); baseline VA (before aflibercept) 73.2\u2009±\u20099.1 and 70.3\u2009±\u200913.7 letters (p\u2009=\u20090.654); and final VA 73.0\u2009±\u20097.6 and 69.3\u2009±\u200915.6 letters (p\u2009=\u20090.509). VA remained stable (p\u2009=\u20090.761 and 0.964) after 15.5\u2009±\u20093 and 15.1\u2009±\u20093.5 aflibercept injections (p\u2009=\u20090.244). At 24\xa0months, dry macula was noted in 40 to 50% of the eyes (p\u2009=\u20090.620). Complete resolution of polyps was observed in 58% at 12\xa0months and 92% at 24\xa0months.ConclusionsIn 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\xa0months.