Efficiency of aflibercept in clinical practice

    Abstract

    Efficiency of aflibercept in clinical practice

    A.V. Kulagina

    The Clinic «View», Simferopol

    Introduction. Age-related macular degeneration is a leading cause of severe vision loss worldwide, frequently resulting in legal blindness. Implementation of anti-VEGF therapy in clinical practice was an important milestone in the treatment of age-related macular degeneration. Despite various disease manifestations aflibercept (Eylea®) demonstrates its efficacy improving both anatomical and functional vision outcomes.

    Purpose. To study an efficacy in the treatment of patients suffering from pigment epithelial detachment (PED) and wAMD using aflibercept in clinical cases.

    Material and methods. The analysis of 3 clinical cases of treatment in patients with PED and wAMD was performed using intravitreal injections of aflibercept. In the first case the patient had a combined diagnosis – he was treated for both incomplete complicated cataract of the left eye and wet age-related macular degeneration (PED) of the left eye. Previously the patient had been treated with multiple ranibizumab injections and had shown anatomical and vision improvements for about a month after each injection.

    Results. Because of the resistance to the ranibizumab therapy and recurrent PED it was decided to change the medicine. After application of intravitreal aflibercept injections for this patient, a significant improvement of visual acuity was observed already after the first injection (Vis=0.4 before aflibercept injection; Vis=0.7 one month after the first injection). There also were no relapses of pigment epithelium and neuroepithelium detachment (NED). Therewith such an improvement maintained for more than one month and more after aflibercept injection. In the second clinical case the recurrent PED and NED after intravitreal injections of ranibizumab were maintained in spite of improvements of functional indices (VA). After application of intravitreal aflibercept injections the patient demonstrated positive dynamics – the PED flattening and a complete NED disappearance the next day after the injection. A longer follow-up period is required to make final conclusions about the efficacy in this case. The third clinical case demonstrated the correlation of anatomical and functional outcomes. The beneficial effect of aflibercept was noted the second day after the injection – a decrease of NED edema height and a reduced volume of intraretinal and subretinal fluid, a VA improvement (Vis=0.08). Further, according to the OCT the positive dynamics was detected as well – decreased area of macular edema, PED and NED flattering, reduced volume of intraretinal and subretinal fluid, VA improvement (Vis=0.2; Vis=0.02 before treatment).

    Conclusions. Aflibercept (Eylea®) demonstrated a clinical efficacy in treatment of various forms and severity of wAMD. Further observation is required to evaluate long-term outcomes.

    Key words: Wet AMD, RPE detachment, neovascularization, anti-VEGF therapy, aflibercept.