Clinical efficacy of aflibercept treatment in patients with ranibizumab-resistant neovascular age-related macular degeneration

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Abstract

THE AIM was to evaluate clinical efficacy of aflibercept treatment in patients with ranibizumab-resistant neovascular age-related macular degeneration.

MATERIALS AND METHODS. 13 patients (13 eyes) after intravitreal ranibizumab therapy for 1 year (from 6 to 8 injections with an interval of 1.5 to 2 months). However, in all patients, there was a recurrence of the exudative activity of the process. Aflibercept treatment method consisted of 3 monthly “loading” intravitreal injections with follow-up period of 4 months.

RESULTS. One month after 1st aflibercept injection among all patients, the average index of best-corrected visual acuity (BCVA) increased to 0.41 ± 0.02 and the central retinal thickness (CRT) index decreased to 307 ± 14.5 μm versus the initial CRT value 431 ± 64 μm. After the 3rd aflibercept injection, the CRT index was the lowest and amounted to 189.5 ± 13.0 μm, which was accompanied BCVA increase to 0.42 ± 0.03 versus 0.29 ± 0.05 as the initial value. According to the optical coherence tomography data, after “loading” phase, good anatomical effect was observed with significant edema reduction, complete resorption of fluid in the subretinal space, and decrease of the pigment epithelial detachment’s height.

CONCLUSION. Evaluating the results of our study, we found that the use of angiogenesis inhibitor aflibercept made it possible to suppress the signs of activity of choroidal neovascularization and to obtain additional improvement of visual functions in patients with neovascular age-related macular degeneration, when the therapeutic effect from the early ranibizumab therapy was insufficient or completely absent.

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About the authors

Victor V. Egorov

S.N. Fyodorov Eye Microsurgery Federal State Institution, the Khabarovsk Branch; Postgraduate Institute for Public Health Workers

Email: naukakhvmntk@mail.ru
ORCID iD: 0000-0002-9888-7353
SPIN-code: 9253-3870
Scopus Author ID: 7202505024
ResearcherId: S-4718-2017

Dr. Sci. (Med.), Professor

Russian Federation, 211 Tikhookeanskaya str., Khabarovsk, 680033; Khabarovsk

Galina P. Smoliakova

S.N. Fyodorov Eye Microsurgery Federal State Institution, the Khabarovsk Branch; Postgraduate Institute for Public Health Workers

Email: naukakhvmntk@mail.ru
ORCID iD: 0000-0002-6943-5518
SPIN-code: 8667-1885
Scopus Author ID: 6701803515
ResearcherId: AAI-4284-2020

Dr. Sci. (Med.), Professor

Russian Federation, 211 Tikhookeanskaya str., Khabarovsk, 68003; Khabarovsk

Lubov P. Danilova

S.N. Fyodorov Eye Microsurgery Federal State Institution, the Khabarovsk Branch; Postgraduate Institute for Public Health Workers

Author for correspondence.
Email: naukakhvmntk@mail.ru
ORCID iD: 0000-0003-0665-1755
SPIN-code: 2351-9335
Scopus Author ID: 57201738494

ophthalmologist

Russian Federation, 211 Tikhookeanskaya str., Khabarovsk, 680033; Khabarovsk

Natalya S. Zhajvoronok

S.N. Fyodorov Eye Microsurgery Federal State Institution, the Khabarovsk Branch

Email: naukakhvmntk@mail.ru
ORCID iD: 0000-0001-5515-4099
SPIN-code: 3656-0499
Scopus Author ID: 57209689493

ophthalmologist

Russian Federation, 211 Tikhookeanskaya str., Khabarovsk, 680033

Yulia B. Solov'yeva

Postgraduate Institute for Public Health Workers

Email: naukakhvmntk@mail.ru
ORCID iD: 0000-0003-1988-6449
SPIN-code: 9976-8618

Assistant of the Department of Ophthalmo­logy

Russian Federation, Khabarovsk

Anzhelika N. Polosina

City Hospital No. 11

Email: naukakhvmntk@mail.ru
ORCID iD: 0000-0002-2062-0528
SPIN-code: 4092-1355

ophthalmologist

Russian Federation, Khabarovsk

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2. Fig. 1. Dynamics of optical coherence tomography and visometry data of 65-year-old patient N. with neovascular age-related macular degeneration at ranibizumab treatment in pro re nata mode: a – at baseline; b – after the 1 injection; c – after 2 injections; d – after 3 injections; e – after 1.5 months following 3 injections; f – after 2 months following 4 injections; g – after 2.5 months following 5 injections; h – after 9 months following the initial presentation – recurrence; i – after 11 months following the initial treatment (after the 8th injection)

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3. Fig. 2. Dynamics of changes in best-corrected visual acuity (BCVA) indices over time: initial level and those at various times after intravitreal aflibercept injections (IAI)

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4. Fig. 3. Dynamics of changes in indices of central retinal thickness (CRT) at various times after intravitreal aflibercept injections (IAI)

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5. Fig. 4. Dynamics of optical coherence tomography and visometry data of 65-year-old patient N. with neovascular age-related macular degeneration at aflibercept treatment against the background of tachyphylaxis after 8 intravitreal ranibizumab injections: a – after 12 months after initial presentation(after 8 ranibizumab injections); b – after 1 month following the 1st aflibercept injection; c – after 2 aflibercept injections; d – after 3 aflibercept injections

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Copyright (c) 2021 Egorov V.V., Smoliakova G.P., Danilova L.P., Zhajvoronok N.S., Solov'yeva Y.B., Polosina A.N.

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