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The efficacy and safety of intravitreal aflibercept in the treatment of wet age related macular degeneration in difficult cases of non responders to intravitreal Ranibizumab: influence of anatomic characteristics on visual outcomes

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Session Details

Session Title: Special Cases
Session Date/Time: Friday 26/02/2016 | 08:30-10:00
Paper Time: 09:54
Venue: MC3 Room
First Author: : V.Achtsidis GREECE
Co Author(s): :    E. Kozanidou   L. Menon   A. Patwardhan   P. Ravindranath     

Abstract Details


With the increasing burden on patients and healthcare providers with a monthly frequency of monitoring and treatment of Wet ARMD with anti VEG-F agents, the 2Q8 regimen (2 mg every 8 weeks after 3 initial monthly doses) of Intravitreal (IVT) Aflibercept has been a major development . The purpose of this study was to analyse the safety and efficacy of IVT Aflibercept in the treatment of visual impairment caused by neovascular Wet ARMD in difficult cases of not responding to previous Intravitreal Ranibizumab.


Eye Department, Royal Cornwall Hospitals NHS Trust, UK 2nd Department of Ophthalmology, “Attikon” University Hospital, Athens, Greece


A retrospective analysis of 48 patients (52 eyes) treated with the 2Q8 regime was undertaken. All patients were previously treated with Intravitreal Ranibizumab. The main indication for switch to Intravitreal Aflibercept was a poor response to Ranibizumab with persistent or worsening subretinal fluid (SRF) after six consecutive doses.


Primary Endpoint: Proportion of patients who maintained vision (lost < 15 letters of BCVA) was 92 %. Mean Baseline Vision: 50.5 letters. Mean Baseline CRT: 325 microns. Secondary Endpoints: Mean Number of Injections was 4.5 injections over a mean duration of follow up of 7 months. Mean change in Central Retinal Thickness CRT from baseline: -19.11 microns. 3.8% incidence of adverse events. No incidence of endopththalmitis. Mean change in BCVA from baseline to last appointment: 0.55 letters. 3 Patients (5.8%) gained 15 letters or more from baseline. 3 patients (5.8%) were switched back to Lucentis as visual deterioration noted before 8 weeks.


Intravitreal Aflibercept certainly showed a favourable outcome with stabilization of vision achieved in 92% of patients and reduction of the mean CRT underling the anatomical improvement of the macula. It was well tolerated with no significant increase in adverse events and no incidence of endophthalmitis. The 2Q8 regime helped to potentially decrease the number of follow ups for patients with lesser risk compared to a monthly intravitreal procedure. However, there was a 5.8 % incidence of switch back to Ranibizumab treatment highlighting the need for careful selection and monitoring, tailored to each individual patient.

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