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Effects of aflibercept for ranibizumab-resistant neovascular age-related macular degeneration and polypoidal choroidal vasculopathy

  • Retinal Disorders
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Abstract

Purpose

To evaluate visual and anatomic outcomes in response to the conversion of treatment in patients with neovascular age-related macular degeneration (AMD) and polypoidal choroidal vasculopathy (PCV) refractory to previous treatment. We also investigated the effect of genetic factors.

Methods

We recruited patients with AMD or PCV refractory to ranibizumab and initiated aflibercept treatment. Changes in the logarithm of minimum angle of resolution (logMAR) and central retinal thickness (CRT) measured using optical coherence tomography (OCT) 6 months after the conversion were compared between the AMD and PCV groups. We also genotyped each patient for the ARMS2 A69S, CFH Y402H, and I62V alleles, and investigated the association between genotype and treatment response.

Results

Mean age of the participants was 75.6 ± 8.0 years. There were 15 patients with AMD and 26 patients with PCV. While PCV patients gained about 1 line of vision (0.40 ± 0.37 to 0.31 ± 0.40, P = 0.003), AMD patients did not show significant improvement (0.41 ± 0.37 to 0.42 ± 0.39, P = 0.699) despite the decrease in CRT (202.1 ± 113.7 to 131.2 ± 55.7 μm, P = 0.003). The prevalence of dry retina after treatment was higher among PCV patients (80.8 vs 46.7 %, P = 0.024). There was no significant difference between patients with risk and non-risk alleles for ARMS2 A69S, CFH Y402H, and I62V.

Conclusion

In AMD or PCV patients refractory to ranibizumab, switching to aflibercept is generally effective regardless of patient genotype. PCV patients may benefit more significantly than AMD patients.

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Acknowledgments

The authors thank Dr. Hiroshi Tamura for helpful advice on this manuscript.

Funding/support

This research was supported in part by grants-in-aid for scientific research from the Japan Society for the Promotion of Science (No. 21592256) and the Innovative Techno-Hub for Integrated Medical Bio-Imaging of the Project for Developing Innovation Systems, from the Ministry of Education, Culture, Sports, Science and Technology (MEXT), Japan.

Conflicts of interest

Nagahisa Yoshimura receives financial support from Topcon, Nidek, and Canon. He is also a paid consultant of Nidek. Akitaka Tsujikawa receives financial support from Pfizer.

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Authors and Affiliations

  1. Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, 54, Shougoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan

    Yu Kawashima, Akio Oishi, Akitaka Tsujikawa, Kenji Yamashiro, Masahiro Miyake, Naoko Ueda-Arakawa, Munemitsu Yoshikawa, Ayako Takahashi & Nagahisa Yoshimura

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  1. Yu Kawashima
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Correspondence to Akio Oishi.

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Kawashima, Y., Oishi, A., Tsujikawa, A. et al. Effects of aflibercept for ranibizumab-resistant neovascular age-related macular degeneration and polypoidal choroidal vasculopathy. Graefes Arch Clin Exp Ophthalmol 253, 1471–1477 (2015). https://doi.org/10.1007/s00417-014-2838-5

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  • DOI: https://doi.org/10.1007/s00417-014-2838-5

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