Atlas of Ophthalmology

Aflibercept Treatment in Recalcitrant Exudative AMD (SD-OCT, FFA, Colour Fundusphotography)

Retina -> Aquired Macular Diseases
Patient: 84 years of age, male, BCVA 0.5 at OS. Ocular medical history: primary open angle glaucoma, in 07/2013 exsudative AMD at OS with drop of BCVA from 0.7 to 0.3, incomplete response to 3 Ranibizumab anti-VEGF injections from 08/2013 to 10/2013, in 11/2013 patient received 0.05 mL open-label intravitreal injections of 2.0 mg aflibercept (Eylea®) administered every 28 days for 2 months, BCVA increased from 0.4 to 0.5 . General medical history: empty. Purpose: to show the effect of aflibercept (Eylea®) improving recalcitrant exudative AMD. Methods: Fundus photography, fluorescein angiography (Spectralis HRA+OCT, Heidelberg Engineering, Heidelberg), Spectral domain OCT (SD-OCT, Spectralis HRA+OCT, Heidelberg Engineering, Heidelberg). Findings: SD-OCT: image of 07/2012 showed regular retinal pigmentepithelium, image of 06/2013 showed detachment of retinal pigmentepithelium , image of 10/2013 showed thin detachment of retinal pigmentepithelium, , image of 11/2013 showed recalcitrant exudative AMD with detachment of retinal pigmentepithelium, image of 01/2014 showed flattening of pigment epithelial detachment from 11/2013. Fluorescein angiography: exudative AMD. Colour Fundusphotography: central atrophy and hyperpigmentation of retinal pigmentepithelium in 06/2013. Discussion: Neovascular age-related macular degeneration (AMD) is a leading cause of vision loss . As pharmaceutical agents blocking vascular endothelial growth factor-A (VEGF) were used ranibizumab (Lucentis, Genentech, South San Francisco, California, USA), bevacizumab (Avastin, Genentech, South San Francisco, California, USA), or aflibercept (Eylea, Regeneron, Tarrytown, New Jersey). Recalcitrant exudative AMD is a substantial clinical burden, representing approximately a third of all new wet AMD eyes. Wykoff et al. reported (1), that despite monthly treatment with anti-VEGF agents for 2 years, about 51% of patients treated with ranibuzumab and about 67% of patients given bevacizumab showed evidence of persistent fluid. Similarly, in the VIEW1 and VIEW2 trials about 30% of patients had evidence of persistent intraretinal or subretinal fluid despite 2.0 mg aflibercept treatment. Wykoff et al. concluded in (1) that (a) 2.0 mg aflibercept treatment led to significant mean anatomic improvement, primarily driven by 20% of the patients, and (b) aflibercept treatment may be anatomically valuable in some recalcitrant exudative AMD eyes. Literature: (1) Wykoff CC, Brown DM, Maldonado ME, Croft DE. Aflibercept treatment for patients with exudative age-related macular degeneration who were incomplete responders to multiple ranibizumab injections (TURF trial). Br J Ophthalmol.2014 Feb 11. doi: 10.1136/bjophthalmol-2013-304736.

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