Background Intravitreal aflibercept is approved in the treatment of neovascular age-related macular degeneration (AMD). The duration of its effect is higher than that of ranibizumab and bevacizumab but the effectiveness in patients who do not respond to these treatments is unknown.

Purpose To evaluate the efficacy of intravitreal aflibercept on best-corrected visual acuity (BCVA) and central retinal thickness (CRT) in refractory AMD.

Material and methods Prospective observational study in patients diagnosed with AMD treated with aflibercept, who didn’t respond to ranibizumab and/or bevacizumab.

Variables: BCVA (ETDRS optotypes) and CRT obtained on optical coherence tomography (OTC 3-D).

Statistics: Wilcoxon test for paired data and Student t test for paired data, considering results significant if p value <0.05.

Results A total of 27 eyes from 24 patients were included, 20 of them were females. The median age was 76.98 ± 9.9 years old. 12.5% of the patients received bilateral treatment. 22.2% of the eyes were previously treated with photodynamic therapy (PDT), 70.4% with ranibizumab (average 7.5 injections/eye, range 2–24) and 77.8% with bevacizumab (average 8 injections/eye, range 1–33). 52% of the eyes had been treated with both ranibizumab and bevacizumab.

The average number of aflibercept injections per eye was 3.3 (1–10). In 63% of the eyes there was an increase in BCVA, 7.5% of the eyes maintained the previous BVCA and 29.6% lost vision. ETDRS before and after treatment was 60.4 ± 2.5 vs. 62.3 ± 3.2 letters (p = 0.0504). 89% of eyes experienced a decrease in the CRT measured by OCT, 324.9 ± 22.2 vs. 245.5 ± 13.4 mcm (p < 0.01).

Conclusion Aflibercept is effective in refractive AMD. We obtained a better anatomical response than visual. Due to the duration of the study we expected a greater effect with repeated administrations.

References and/or acknowledgements No conflict of interest.