Wydanie specjalne czerwiec 2014
ranibizumab, aflibercept, bewacyzumab, zwyrodnienie plamki związane z wiekiem (AMD), neowaskularyzacja naczyniówkowa (CNV), inhibitory czynnika wzrostu śródbłonka naczyń (anty-VEGF), optyczna koherentna tomografia (OCT).
Results of Intravitreal Aflibercept Treatment in Eyes Resistant to Ranibizumab and Bevacizumab in Patients with Exudative Age-related Macular Degeneration
Agnieszka Kubicka-Trząska, Izabella Karska-Basta, Joanna Miniewicz-Kurkowska, Piotr Oleksy, Monika Węglarz, Joanna Kobylarz, Bożena Romanowska-Dixon
Klinika Okulistyki i Onkologii Okulistycznej Katedry Okulistyki
Uniwersytetu Jagiellońskiego Collegium Medicum w Krakowie
Kierownik: prof. dr hab. n. med. Bożena Romanowska-Dixon
Summary: Purpose: To evaluate the outcome of aflibercept intravitreal injections in cases with exudative age-related macular degeneration resistant to other
anti-VEGF agents: bevacizumab and ranibizumab.
Material and Methods: A retrospective chart review was conducted to identify patients with exudative age-related macular degeneration resistant to treatment with ranibizumab or bevacizumab who were switched to treatment with 3 monthly injections of aflibercept (Eylea, Bayer). In total, 10 eyes from 10 patients were included. In all cases ophthalmic examination with additional optical coherence tomography were performed every four weeks. Best corrected visual acuity, central macular thickness in optical coherence tomography, and number of injections were reviewed.
Results: The number of prior injections with either bevacizumab or ranibizumab ranged from 3–14 (mean: 8.9). Before treatment conversion best corrected visual acuity ranged from 0.05–0.40 (mean: 0.2) and central retinal thickness was from 266–532 µm (mean: 308.8 µm). Persistent subretinal fluid was present in 3 eyes, sub-retinal pigment epithelium fluid – in 4 eyes and residual subretinal and sub-retinal pigment epithelium fluid was detected in 3 eyes. After three monthly injections of alibercept, the best corrected visual acuity improved and central retinal thickness was reduced compared with baseline, with mean improvement of 1 line of best corrected visual acuity and mean central retinal thickness achieved 201.9 µm in central retinal thickness (range: 178–333 µm). Eight eyes were dry after a single aflibercept injection.
Conclusion: Aflibercept therapy appears to be beneficial in patients with neovascularization who exhibit resistant intraretinal or subretinal fluid following multiple injections with either bevacizumab or ranibizumab. Further follow-up is required to determine whether best corrected visual acuity and central retinal thickness improvements after aflibercept conversion can be maintained.
Słowa kluczowe: iniekcje doszklistkowe, tachyfilaksja, czynnik anty-VEGF, wysiękowa postać zwyrodnienia plamki związanego z wiekiem.
Keywords: intravitreal injections, anti-VEFG factor, tachyphylaxis, exudative age-related macular degeneration.