Background Intravitreal aflibercept is an alternative for treatment of wet age related macular degeneration (AMD) that has theoretical advantages over other antivascular endothelial growth factors (anti-VEGF) which only bind to VEGF-A. This drug also binds to VEGF-B and placental growth factor, two additional factors of neovascularisation.

Purpose To evaluate the response of intravitreal aflibercept in patients with wet AMD previously treated with bevacizumab and ranibizumab.

Material and methods Retrospective analysis included wet ADM patients that were treated with 2 mg of intravitreal aflibercept injections. Initially patients received 3 monthly injections, followed by bimonthly injections. Aflibercept was included as a thirdline treatment of ADM in patients refractory to monthly intravitreal injections of bevacizumab and ranibizumab (as firstline and secondline treatments, respectively) or with contraindications to these treatments. We identified in our electronic medical records all patients who were treated with aflibercept and reviewed the medical histories. Collected data were: number of patients, number of eyes treated, patient age and gender, number of bevacizumab, ranibizumab and aflibercept injections, and number of eyes that showed an improvement in quality of vision and/or ocular lesions. Patients were tested for best corrected visual acuity and optical coherence tomography.

Results

• Patients treated with aflibercept as thirdline treatment: 18 (20 eyes).

• Age (mean±SD): 73 ± 9 years.

• Intravitreal injections of.

• Bevacizumab: 11.15 ± 5.24 injections/eye.

• Ranibizumab: 2.80 ± 0.83 injections/eye.

• Aflibercept: 2.60 ± 1.85 injections/eye.

• Eyes that showed an improvement in quality of vision and/or ocular lesions: 7 (12 eyes remained stable and 1 showed vision loss).

• Patients treated with aflibercept as secondline treatment (due to high cardiovascular risk, macular bleeding and/or vision loss related to bevacizumab): 3 (3 eyes).

• Intravitreal injections of aflibercept: 2 injections/eye.

Conclusion A proportion of persistent wet AMD cases, despite regular bevacizumab and ranibizumab treatment, responded to aflibercept. It was well tolerated with no adverse events even in high cardiovascular risk patients. More time is necessary to evaluate long term efficacy. Based on these findings, its different mechanism of action and the reduction in the number of administrations, aflibercept is proposed as a secondline therapy for wet AMD.

References and/or Acknowledgements No conflict of interest.