Aflibercept efficacy in refractory choroidal neovascularization.

: The aim of the report is to evaluate the short-term efficacy and safety of aflibercept (EYLEA®) in patients with choroidal neovascularization (CNV) transformed into refractory during treatment with bevacizumab (AVASTIN ®). METHODS: Clinical, morphological, and functional changes were retrospectively evaluated in cases with refractory CNVs to monthly 1.25 mg bevacizumab intravitreal injections (AVASTIN ®) and switched to 3 monthly 2.0 mg intravitreal injections of aflibercept (EYLEA ®). RESULTS: In this pilot evaluation, 8 cases of CNVs that become refractory to intravitreal treatment with 1.25 mg intravitreal bevacizumab (AVASTIN ®), were switched to 2.0 mg intravitreal aflibercept (EYLEA ®) and evaluated. The mean age of patients was 67.6 years (54-74 years). In 7 cases, CNV was associated to age related macular degeneration and in 1 case to angioid streaks. The mean number of previous intravitreal bevacizumab (AVASTIN®) administrations was 9.32 (7-12). In all cases, the last 3 intravitreal injections of bevacizumab were performed at an interval of maximum 6 weeks. The refractory status was confirmed by the lack of improvement or worsening of the clinical features as revealed by SD-OCT. A slowly anatomical improvement was noticed in 5 out of 8 cases (62.5%) since the first aflibercept administration. The anatomical improvement was stable after 3 monthly administrations. During the treatment, only 3 out of 5 cases (60%) showing anatomical improvement had a minor visual benefit (one line of VA gain). In 3 cases, the treatment change was unremarkable. No side effects were noticed. CONCLUSIONS: The anatomical improvement confirms previous reports regarding the efficacy and safety of aflibercept (EYLEA®) in some cases of CNV that became refractory during conventional anti-VEGF therapy. The improvement can be, at least partially, explained by the more complex features of aflibercept. Unfortunately, a minor visual benefit was noticed in a limited number of cases.