Daniel Constantin Brănişteanu1,2, Andrei Bîlhă3, Andreea Moraru1,3. 1. Ophthalmology Department, "Gr. T. Popa" University of Medicine and Pharmacy, Iasi, Romania. 2. "RETINA CENTER" Eye Clinic, Iasi, Romania. 3. Ophthalmology Clinic, "N. Oblu" Clinical Emergency Hospital, Iasi, Romania.
Abstract
The aim of the report is to evaluate the short-term efficacy and safety of aflibercept (EYLEA®) in patients with choroidal neovascularization (CNV) transformed into refractory during treatment with bevacizumab (AVASTIN ®). METHODS: Clinical, morphological, and functional changes were retrospectively evaluated in cases with refractory CNVs to monthly 1.25 mg bevacizumab intravitreal injections (AVASTIN ®) and switched to 3 monthly 2.0 mg intravitreal injections of aflibercept (EYLEA ®). RESULTS: In this pilot evaluation, 8 cases of CNVs that become refractory to intravitreal treatment with 1.25 mg intravitreal bevacizumab (AVASTIN ®), were switched to 2.0 mg intravitreal aflibercept (EYLEA ®) and evaluated. The mean age of patients was 67.6 years (54-74 years). In 7 cases, CNV was associated to age related macular degeneration and in 1 case to angioid streaks. The mean number of previous intravitreal bevacizumab (AVASTIN®) administrations was 9.32 (7-12). In all cases, the last 3 intravitreal injections of bevacizumab were performed at an interval of maximum 6 weeks. The refractory status was confirmed by the lack of improvement or worsening of the clinical features as revealed by SD-OCT. A slowly anatomical improvement was noticed in 5 out of 8 cases (62.5%) since the first aflibercept administration. The anatomical improvement was stable after 3 monthly administrations. During the treatment, only 3 out of 5 cases (60%) showing anatomical improvement had a minor visual benefit (one line of VA gain). In 3 cases, the treatment change was unremarkable. No side effects were noticed. CONCLUSIONS: The anatomical improvement confirms previous reports regarding the efficacy and safety of aflibercept (EYLEA®) in some cases of CNV that became refractory during conventional anti-VEGF therapy. The improvement can be, at least partially, explained by the more complex features of aflibercept. Unfortunately, a minor visual benefit was noticed in a limited number of cases.
The aim of the report is to evaluate the short-term efficacy and safety of aflibercept (EYLEA®) in patients with choroidal neovascularization (CNV) transformed into refractory during treatment with bevacizumab (AVASTIN ®). METHODS: Clinical, morphological, and functional changes were retrospectively evaluated in cases with refractory CNVs to monthly 1.25 mg bevacizumab intravitreal injections (AVASTIN ®) and switched to 3 monthly 2.0 mg intravitreal injections of aflibercept (EYLEA ®). RESULTS: In this pilot evaluation, 8 cases of CNVs that become refractory to intravitreal treatment with 1.25 mg intravitreal bevacizumab (AVASTIN ®), were switched to 2.0 mg intravitreal aflibercept (EYLEA ®) and evaluated. The mean age of patients was 67.6 years (54-74 years). In 7 cases, CNV was associated to age related macular degeneration and in 1 case to angioid streaks. The mean number of previous intravitreal bevacizumab (AVASTIN®) administrations was 9.32 (7-12). In all cases, the last 3 intravitreal injections of bevacizumab were performed at an interval of maximum 6 weeks. The refractory status was confirmed by the lack of improvement or worsening of the clinical features as revealed by SD-OCT. A slowly anatomical improvement was noticed in 5 out of 8 cases (62.5%) since the first aflibercept administration. The anatomical improvement was stable after 3 monthly administrations. During the treatment, only 3 out of 5 cases (60%) showing anatomical improvement had a minor visual benefit (one line of VA gain). In 3 cases, the treatment change was unremarkable. No side effects were noticed. CONCLUSIONS: The anatomical improvement confirms previous reports regarding the efficacy and safety of aflibercept (EYLEA®) in some cases of CNV that became refractory during conventional anti-VEGF therapy. The improvement can be, at least partially, explained by the more complex features of aflibercept. Unfortunately, a minor visual benefit was noticed in a limited number of cases.
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