Switch to a single dose of aflibercept in bevacizumab nonresponders with AMD

Objective: This study aimed to report on the efficacy of 1 dose of aflibercept in bevacizumab nonresponders. Design: This was a retrospective, single-centre, interventional, noncomparative study. Participants: This study retrospectively analyzed 23 patients with persistent intraretinal or subretinal fluid treated with 6 or more monthly bevacizumab injections. Methods: Patients were switched to 1 dose of aflibercept and afterward continued their therapy with bevacizumab for at least another 6 months. We performed spectral domain optical coherence tomography monthly and evaluated visual acuity, central retinal thickness, and photoreceptor defects. The main outcome measures were visual and anatomic outcome 1 and 6 months after administering aflibercept. Results: Visual acuity significantly improved (p = 0.01) after the switch to aflibercept (from 0.39 to 0.49 Snellen). This improvement was stable for the remaining 6 months of the study (final visual acuity, 0.46 Snellen); 47% of patients experienced an improvement of at least 5 letters from baseline on a chart of the ETDRS type (Early Treatment Diabetic Retinopathy Study). Central retinal thickness decreased from 521 mu M to 446 pm (p = 0.01) and remained stable for the next 6 months (452 pm). Complete resolution of intraretinal and subretinal fluid was observed in 30% of eyes. Conclusions: In bevacizumab nonresponders, switching to a single dose of aflibercept before continuing the therapy with bevacizumab improves visual outcome and anatomic results.