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How to deal with persistent activity of the macular neovascular membrane ?

Author: Ma_gorzata Wichrowska (Poland)

Co-authors: Wojciech Suda, Jarosław Kocięcki

Purpose

The aim of the study was to investigate whether the switch from intravitreal aflibercept (IVA) to intravitreal ranibizumab (IVR) and than switchback to IVA, show effectiveness in the management of patients with wet age-related macular degeneration (wAMD) poorly responding for primary therapy with at least 7 injections of IVA, and than at least 7 injections of IVR.

Setting/Venue

Data show that efficacy of anti-VEGFs in therapy of wAMD is undeniable. However, there are patients whose response is insufficient and we observe sub- or intraretinal fluid despite treatment, which is indicative of persistent activity of the disease. A scheme of dealing with such patients has not been established. Thus we would like to share our experiences.

Methods

Retrospective comparative case series study. We included 20 eyes of 20 patients. Best corrected visual acuity (BCVA), central retinal thickness (CRT), and the presence of subretinal and intraretinal fluid (SRF, IRF, respectively) were assessed. We divided the study population into two groups, treated before enrollment (n=8, 40%), and treatment-naïve (n=12, 60). Data was analysed using R 4.0.2 statistical software.

Results

Statistical analysis showed improvement of BCVA and CRT parameters only in the previously untreated group. However, no statistically significant changes in the presence of IRF and SRF were found.

Conlusions

Treatment conversion according to the aflibercept- ranibizumab- aflibercept regimen may be beneficial for patients poorly responding to primary therapy. The presence of persistent intra- and subretinal fluid is not a sufficient indicator of treatment effectiveness, because subjective and objective improvements in visual acuity may be noticeable despite the presence of fluid. Previously untreated patients achieve the greatest benefit from treatment.

Financial Disclosure

no funding or grant support

Comments

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