Influence of pigment epithelial detachment on visual acuity in neovascular age-related macular degeneration

Pigment epithelial detachment (PED), the anatomical separation of the retinal pigment epithelium from the Bruch membrane, is common in many chorioretinal diseases, including neovascular age-related macular degeneration. PED is present in about 30% to 80% of neovascular age-related macular degeneration patients based on the CATT, EXCITE, and VIEW studies. The influence of PED on visual acuity is controversial as a result of inconsistent results reported by various studies. With advances in imaging technologies, it is possible to evaluate not only the presence or absence of PED, but also detailed quantitative parameters, such as height, width, greatest linear diameter, area, volume, and reflectivity within the PED. We performed a comprehensive literature review to evaluate the relationship of PED with visual acuity. In summary, the presence or persistence of a PED may still be compatible with relatively good visual acuity. There is no strong evidence that the presence of a PED or aspects of its morphology has a significant impact on visual acuity. The presence of a PED may be predictive of the need for more regular treatment. More well-designed studies with standardized PED definitions and classifications are needed to evaluate the relationship between PED and visual acuity.     

Visual acuity outcomes in ranibizumab-treated neovascular age-related macular degeneration; stratified by baseline vision

Background: Ranibizumab (Lucentis, Novartis, Basel, Switzerland) is currently indicated for use in neovascular age‐related macular degeneration (NVAMD). This study assessed the real‐life outcomes based on baseline visual acuity when treated with intravitreal ranibizumab on a three + pro re nata (PRN) dosing schedule for NVAMD. Design: This retrospective chart‐review was conducted at King's College Hospital. The patients were stratified into three groups based on baseline Early treatment diabetic retinopathy study (ETDRS) letters: 27 with poor visual acuity (24–34 letters), 33 with intermediate visual acuity (35–54 letters) and 27 with good visual acuity (≥=55 letters). Methods: All patients received a three + PRN dosing schedule of ranibizumab injections (0.5 mg per 0.05 mL) based on changes in visual acuity and macular thickness on optical coherence tomography (OCT) and all patients completed 12‐month follow up. Main Outcome Measures: The mean change in visual acuity at 12 months in the three groups. Results: Mean gain in ETDRS letters at 12 months was +14.00 (P < 0.0001), +7.10 (P = 0.012) and +2.85 (P = 0.19), and mean number of injections was 5.30, 6.12 and 5.70 in the poor, intermediate and good baseline vision group, respectively, over the 12‐ month follow‐up period. Conclusions: Poor baseline visual acuity (24–34 ETDRS letters) is a predictor of maximum gain in visual acuity. However, eyes with better baseline visual acuity (55 letters) had a better final visual acuity.     

Comparison of visual acuity outcomes between ranibizumab and bevacizumab treatment in neovascular age-related macular degeneration

AIM: To compare visual acuity (VA) outcomes between intravitreal injection of bevacizumab and ranibizumab in the treatment of neovascular age-related macular degeneration (AMD). METHODS: We conducted a consecutive, retrospective case series study in patients with newly diagnosed all type choroidal neovascularization (CNV) secondary to AMD who received an intravitreal injection of bevacizumab (1.25mg) or ranibizumab (0.3mg) at Lions Eye Institute, Western Australia from Mar. 2006 to May 2008. All patients received injection at baseline with additional monthly injections given at the discretion of the treating physician. Main outcome measures were changes in VA. RESULTS: There were 371 consecutive patients received injection at least in one eye with at least 6 months of follow up (median of 12.0 months). Bevacizumab treatment prevented 221 out of 278 (79.5%) patients from losing < 15 letters in VA compared with 79 out of 93 (84.9%) of ranibizumab treated patients (P=0.25). While 68 (24.5%) of bevacizumab treated patients gained ≥15 letters of VA compared with 24 (25.8%) of ranibizumab treated patients (P=0.79). 75.3% and 66.2% patients benefited from ranibizumab and bevacizumab respectively with final VA better than 6/60 (P=0.10). Multivariate analysis showed that pre-treatment VA was negatively associated with benefit outcome. Assignment of injection was not associated with VA outcome of benefit after adjusting the covariate (P=0.857). CONCLUSION: There are no difference in treatment efficacy in terms of VA between bevacizumab and ranibizumab in routine clinical condition.     

Six-year outcomes in neovascular age-related macular degeneration with ranibizumab

AIM: To evaluate the outcomes of (6y ranibizumab therapy in neovascular age-related macular degeneration (AMD). METHODS: HELIX was a retrospective, observational effectiveness study using medical records of patients treated in three clinics in Belgium. Patients had neovascular AMD and were initially treated with intravitreal ranibizumab (0.5 mg) between November 1, 2007 and October 31, 2008, had (6y of data available, and were treated on an ongoing, as-needed basis. Outcomes included best-corrected visual acuity (BCVA) and central retinal thickness (CRT). RESULTS: The sample consisted of 88 eyes from 69 patients. Mean age was 76.4±6.5y, most patients were female (62.3%). Most eyes (62.5%) were treatment-naive, 33 previously treated eyes had received predominantly other anti-vascular endothelial growth factor agents and verteporfin. Mean baseline BCVA was 57.4±12.7 ETDRS letters and CRT was 291.5±86.1 (m. On average, patients received 20.6±11.9 ranibizumab injections over the (6y. Intervals between injections were on average 12.7±16.1wk. Mean change in BCVA from baseline to last observation for the sample was less than one letter (-0.9±17.3 letters), with an average loss of -3.2±15.6 letters in previously treated eyes versus a gain of 0.6±18.4 letters in treatment-naïve eyes. When considering a loss of <15 letters over 6y as stabilization of disease, 75.9% of all eyes showed a positive (improvement or stabilization) outcome. Mean change in CRT from baseline to last observation for the sample was -26.9±148.4 (m with the greatest reduction observed in treatment-naive eyes. CONCLUSION: This retrospective study of 69 neovascular AMD patients treated for (6y with ranibizumab demonstrates long-term visual stabilization. In light of the natural evolution of the disease, these data confirm that ranibizumab is effective long-term under real-world conditions of heterogeneity of patients, clinicians, and centers.     

Relationship between macular pigment and visual acuity in eyes with early age‐related macular degeneration

Purpose: Today the extent to which MP impacts visual function in early AMD remains unclear. This study examines the relationship between macular pigment optical density (MPOD) and high‐contrast visual acuity (HC‐VA) and low‐contrast visual acuity (LC‐VA) in eyes with early age‐related macular degeneration (AMD). Methods: Measurements were made in 22 subjects with early AMD and 27 healthy control subjects. Distance best‐corrected VA was measured using HC (96%) and LC (10%) Bailey‐Lovie logMAR letter charts under photopic luminance conditions. MPOD was determined at the fovea through apparent motion photometry using the cathode ray tube‐based Metropsis psychophysical vision test (Cambridge Research Systems). Results: No significant differences in foveal MPOD were detected between the control eyes (0.30 ± 0.24 log units) and eyes with early AMD (0.27 ± 0.15 log units). Neither were differences detected between the two groups in mean HC‐ and LC‐VA. Foveal MPOD showed significant correlation with both photopic HC‐VA (r = ?0.47, p = 0.0008) and LC‐VA (r = ?0.46, p = 0.0008) such that as MPOD increased, photopic HC‐VA and LC‐VA improved (lower logMAR values). Conclusions: Low MP levels were related to worse visual function in both healthy eyes and eyes with early AMD. Our findings provide direction for future studies designed to improve retinal function through the use of oral supplements known to increase MP levels, especially in eyes with AMD and a low MPOD.     

Long-term outcomes of ranibizumab treatment in neovascular age-related macular degeneration

AIM: To investigate 3-year results in our neovascular age related macular degeneration (NV-AMD) patients treated with ranibizumab. METHODS: Retrospective study. Visual acuity (VA), a full biomicroscopic examination (anterior segment and fundus), and optical coherence tomography (OCT) findings were noted at every visit. All patients were followed monthly. The VA values for the visits closest to 12, 24, and 36mo were analysed. 101 eyes of 73 patients were enrolled. According to the initial VA, the patients were divided three groups: initial VA ≤35 (Group 1), 36-54 (Group 2), and ≥55 letters (Group 3). After three loading doses of 0.5 mg ranibizumab if retreatment was needed, again, 0.5 mg ranibizumab was administered RESULTS: Totally 57 of the 101 eyes were from males and 44 were from females. The average age was 75.1 years. The difference on the changes of VA among three groups at 24 and 36mo were statistically significant (P=0.02 and 0.001 respectively). At the end of the 36-month follow-up the VA increase in Group 2 was significant (P=0.001). At the 12, 24, and 36mo visits most of the eyes showed no VA loss and most of these eyes were in Group 1. The average number of injections administered was 7.3 and the average number of visits was 23.9 during the follow-up. CONCLUSION: VA improvement was significant in those with mild initial VA (36-54 letters). Most eyes showed no VA loss regardless of the initial VA. No correlation between the final VA and the average number of injections.     

Real-life experience of ranibizumab therapy for neovascular age-related macular degeneration from Turkey

AIM: To report the real-life experience and clinical results of intravitreal ranibizumab injections to neovascular age-related macular degeneration (nAMD) in a single institution in Turkey. METHODS: A total of 101 eyes of 89 patients with nAMD treated with intravitreal ranibizumab injection, followed up for at least 24mo between 2009 and June 2014, which were evaluated retrospectively. A pro re nata (PRN) treatment protocol was performed after the patients had received three, monthly loading injections. Best corrected visual acuity (BCVA) and central macular thickness measurements were evaluated at baseline and 3, 6, 12, 18, and 24mo. Number of injections and visits were also recorded. RESULTS: Of the 89 patients, 34 (38.2%) were male and 55 (61.8%) were female and the mean age was 74.0±9.5 (52-91)y. The mean follow-up period was 24.82±4.4 (24-29)mo. Mean number of visits was 8.4±1.12 (7-12) in the first year and 6.6±1.33 (4-12) in the second year. The mean number of injections was 5.8±1.6 (3-10) and 4.2±2.2 (0-9) in the first and second year, respectively. The mean BCVA was 59±15.8 letters at baseline by the Early Treatment Diabetic Retinopathy Study (ETDRS) chart. The mean BCVA at 3, 12, and 24mo was 70.3±15.9, 67.9±14.3 and 67.3±16.9 letters, respectively. Improvement in visual acuity for each of the visits from baseline was found to be statistically significant (P<0.01). Visual acuity in 9 eyes at month 3, 7 eyes at month 12, and 13 eyes at month 24 did not change. The mean central macular thickness (CMT) was 437.99±164.78 μm at baseline. The mean CMT was 348.05±138.47 μm, 349.27±139.79 μm, and 344.13±146.30 μm at months 3, 12, and 24, respectively. The decrease in CMT for each of the visits from baseline was found to be statistically significant (P<0.01). CONCLUSION: Anatomical and functional achievement are obtained in our study, but the mean number of injections and visits are found to be lower than the findings reported in randomized controlled clinical trials in the literature. However, the mean number of injections and visits in our study are compatible with the findings reported in real-life experience studies in the literature.     

Switching between ranibizumab and aflibercept for the treatment of neovascular age-related macular degeneration

The introduction of antivascular endothelial growth factor agents such as ranibizumab and aflibercept has revolutionized the management of neovascular age-related macular degeneration. A number of randomized clinical trials have shown that ranibizumab and aflibercept produce similar efficacy and safety outcomes. Most of the switching studies published to date show that efficacy benefits are uncontrolled, retrospective trials with limitations in terms of their selection, monitoring, numbers, and assessment criteria. Based on the published literature to date, we propose arguments for and against switching antivascular endothelial growth factor agents, provide our own perspective on this topic, and suggest a focus for future research.     

Intravitreal aflibercept in neovascular age-related macular degeneration previously treated with ranibizumab

AIM: To report the change in visual acuity and central macular thickness (CMT) following treatment with intravitreal aflibercept injections in patients with neovascular age-related macular degeneration (nAMD) with suboptimum response to ranibizumab. METHODS: This was a retrospective study. The inclusion criteria were patients with nAMD who responded poorly to ranibizumab. Patients then received either 3 consecutive aflibercept injections followed by PRN treatment or PRN alone. Primary endpoints were mean change in best-corrected visual acuity (BCVA) and CMT at 12mo. Secondary endpoints were number of injections and adverse events. RESULTS: Forty-nine eyes from 49 patients met the inclusion criteria and completed 12-month follow up on aflibercept. Thirty-eight eyes received 3 consecutive aflibercept injections followed by PRN treatment and 11 eyes received pro re nata (PRN) injections alone. At 12mo, mean BCVA improved by one letters (logMAR 0.56±0.31 to 0.54±0.34) and mean CMT decreased from 303.9±82.1 to 259.2±108.3 µm. Four percent of eyes gained 15 letters or more, 6% lost more than 15 letters and the remaining 90% had stable BCVA. The mean number of aflibercept injections was 6. There was one case of infectious endophthalmitis. CONCLUSION: Intravitreal aflibercept in patients with nAMD with a previous suboptimal response to ranibizumab resulted in an anatomical improvement in macular appearance at 12mo without a corresponding improvement in visual acuity.     

Assessment of the long-term visual and anatomical outcomes of ranibizumab to treat neovascular age-related macular degeneration

AIM: To investigate the long-term visual and anatomical outcomes of patients who underwent intravitreal ranibizumab monotherapy to treat neovascular age-related macular degeneration (AMD) and followed-up for at least 2y. METHODS: A total of 74 eyes of 74 patients who underwent ranibizumab monotherapy for neovascular AMD were included in this retrospective study. RESULTS: The average patient age was 72.1±6.5 (range, 57-85)y, the average follow-up time 46.2±13.1 (range, 24-75)mo, and the average number of visits 24.1±9.5 (range, 8-48). The mean number of injections in year 1 was 4.5, 1.6 in year 2, 0.9 in year 3, 0.4 on year 4, and 0.1 in the following years. Within the entire follow-up period, the mean number of injections was 7.6±4.4 (range, 2-21). The mean visual acuity was 48.1±15 (range, 15-76) letters at baseline and 45.7±19 (range, 7-75) at year 5. The mean central macular thickness was 303±78 (range, 178-552) μm at baseline and 251±51 (range, 138-359) μm at year 5. Scars developed in 47 (63.5%) eyes at the end of the follow-up period, and atrophy was evident in 6 (8.1%) eyes. CONCLUSION: Ranibizumab monotherapy can stabilize visual acuity for a mean period of 4y in patients with neovascular AMD.     

Predictors of 1‐year visual outcome in neovascular age‐related macular degeneration following intravitreal ranibizumab treatment

Purpose: To describe predictors of visual outcome in patients treated with intravitreal ranibizumab for choroidal neovascularisation (CNV) in age‐related macular degeneration (AMD). Methods: Retrospective review of 279 patients with CNV in AMD who fulfilled MARINA/ANCHOR study eligibility criteria and were treated with repeated intravitreal injections of ranibizumab 0.5 mg in routine clinical practice, beginning with three initial injections at 4‐week intervals followed by individualized retreatment for the subsequent 9 months. Study parameters included best‐corrected visual acuity (BCVA) and morphological characteristics. Results: Mean BCVA relative to baseline was +4.7 (p < 0.0001), +4.2 (p < 0.0001)and ?0.4 (p > 0.667) Early Treatment Diabetic Retinopathy Study letters after 3, 6 and 12 months, respectively, after a mean of 5.1 injections when the proportion of patients with BCVA ≥70 letters had doubled compared with baseline. Predictive factors for BCVA ≤35 letters after 12 months were BCVA ≤35 letters at baseline and month 3 (p < 0.0001) while BCVA ≥70 letters at month 12 was associated with BCVA ≥70 letters at baseline and month 3 (p < 0.001) and with total lesion size <4 DA (p = 0.0147). Conclusion: Under a ranibizumab regimen with substantially fewer injections than with fixed four‐weekly injection regimens, BCVA was improved compared with the natural history of neovascular AMD, but did not achieve the visual gain observed in randomized clinical trials using fixed 4‐week retreatment. Visual acuity at month 3, after the initial fixed‐interval injections, was the strongest predictor of BCVA at month 12.     

康柏西普对提高湿性老年性黄斑变性患者视力的临床效果分析

目的：观察康柏西普对提高湿性老年性黄斑变性患者视力的临床效果。

方法：临床纳入湿性老年性黄斑变性患者70例70眼,根据治疗方案的不同分为研究组与对照组。对照组给予曲安奈德注射液玻璃体腔注射,研究组给予康柏西普注射液玻璃体腔注射。观察两组患者治疗前后裸眼视力变化情况、阅读能力评分、视网膜黄斑色素密度等。

结果：治疗后6mo,1a,研究组视力分别为0.47±0.11、0.60±0.14,对照组视力分别为0.27±0.09、0.30±0.15,两组比较差异有统计学意义(P<0.05); 治疗后6mo,1a,研究组黄斑中心凹视网膜厚度分别为336.8±65.4、301.5±76.8μm,对照组黄斑中心凹视网膜厚度分别为379.4±88.2、368.6±81.3μm,两组比较差异有统计学意义(P<0.05); 治疗后6mo,1a,研究组视网膜黄斑色素密度分别为0.19±0.07、0.25±0.09DU; 对照组视网膜黄斑色素密度分别为0.12±0.05、0.14±0.05DU,两组比较差异有统计学意义(P<0.05)。

结论：玻璃体腔注射康柏西普注射液治疗湿性老年性黄斑变性,具有较好的临床效果,能够显著提高患者裸眼视力,值得推广。     

比较雷珠单抗和贝伐珠单抗对新生血管AMD的疗效

目的：比较玻璃体内注射雷珠单抗与贝伐珠单抗对年龄相关性黄斑变性（ age-related macular degeneration, AMD）的疗效,治疗方案必要时采用。 方法：回顾性分析63例63眼（雷珠单抗治疗组35眼,贝伐珠单抗治疗组28眼）新确诊新生血管年龄相关性黄斑变性患者的资料。治疗12 mo后随访,分析比较两组患者的最佳矫正视力（ BCVA）和黄斑中心凹厚度（ CFT）。采用双尾t检验和单因素方差分析比较两组最佳矫正视力和黄斑中心凹厚度的变化。 结果：雷珠单抗治疗组35眼和贝伐珠单抗治疗组28眼均完成12 mo随访,并记录数据。雷珠单抗治疗组最佳矫正视力均值增加0.1 logMAR;相反,贝伐珠单抗治疗组最佳矫正视力均值下降0.06logMAR（P=0.01）。雷珠单抗治疗组13眼（37%）和贝伐珠单抗治疗组4眼（14%）最佳矫正视力至少增加0.3logMAR。雷珠单抗治疗组平均黄斑中心凹厚度减少41.6μm,贝伐珠单抗治疗组减少8.1μm（P=0.003）。两组平均注射次数是4.46次和4.11次（P〉0.05）。 结论：玻璃体内注射雷珠单抗组在视力和消水肿方面疗效优于贝伐珠单抗组。但是,两种药的疗效和安全性还需要随机的长期临床试验来验证。     

6-weekly bevacizumab versus 4-weekly ranibizumab for neovascular age-related macular degeneration: a 2-year outcome

AIM: To compare visual acuity and central macular thickness (CMT) changes in neovascular age related macular degeneration patients treated with either 6 weekly bevacizumab regimen or 4 weekly ranibizumab on an as required basis. METHODS: Patients made an informed choice between bevacizumab 1.25 mg or ranibizumab 0.5 mg. The selected treatment was administered in the first 3 visits. Bevacizumab patients were followed-up 6 weekly and ranibizumab 4 weekly. Retreatment criteria was based on the reduction of >5 letters in the best-corrected visual acuity (BCVA), the presence of retinal fluid on optical coherence tomography (OCT) or new retinal haemorrhage. RESULTS: Visual acuity at 2y bevacizumab patients gained 7.0 letters and ranibizumab 9.2 (P=0.31, 95% CI -6.4 to 2.0). At 2y 86% of bevacizumab and 94% ranibizumab patients had not lost 15 letters or more (P=0.13). Mean CMT decreased at 2y bevacizumab by 146 µm, ranibizumab 160 µm (P=0.72). Mean number of injections was at 2y bevacizumzb 11.9, ranibizumab 10.3 (P=0.023). CONCLUSION: Bevacizumab 6 weekly on an as required basis was not demonstrably non-inferior to ranibizumab 4 weekly pro re nata (prn) in terms of BCVA and change in CMT. In the bevacizumab group, one more injection was required in the second year compared to the ranibizumab group.     

PDT联合ranibizumab玻璃体腔注射治疗年龄相关性黄斑变性合并CNV

目的：观察 PDT 联合玻璃体腔注射 ranibizumab (雷珠单抗)治疗老年性黄斑变性脉络膜新生血管( choroidal neovascularization,CNV)的疗效。
　　方法：将符合纳入标准,经吲哚青绿脉络膜血管造影(indocyanine green angiography, ICGA)、光学相干断层扫描( optical coherence tomography, OCT)检查确诊为黄斑区脉络膜新生血管( CNV)患者27例27眼,经PDT治疗后3~7 d内行 ranibizumab 玻璃体腔注射。观察治疗后1,3,6 mo、末次随访时行最佳矫正视力、FFA、ICGA、OCT 检查及有无并发症发生情况。
　　结果：最佳矫正视力提高17眼(63%),最佳矫正视力稳定6眼(22%),最佳矫正视力下降4眼(15%)。27例27眼治疗前平均渗漏面积为1005.69±105.47μm,治疗后1,3mo后平均875.54±103.27,423.37±79.68μm,与治疗前比较差异有统计学意义(P<0.01),视网膜黄斑中央厚度27例27眼治疗前平均厚度为485.58±122.59μm,治疗后1,3mo后平均398.84±105.32,297.74±89.18μm,与治疗前比较差异有统计学意义(P<0.01)。
　　结论：PDT 封闭 CNV 后,联合玻璃体内腔内注射ranibizumab,有效阻断新生血管复发,减少PDT再次治疗次数和并发症,可提高治疗效果。     

A computerized resolution visual acuity test in preschool and school age children

AIM: To study if one of the two molecules could lead to a lower number of follow up visits and intra-vitreous injection (IVI) with the same efficacy. METHODS: ELU (or “elected” in French) study is a retrospective study conducted in real life in patients presenting suboptimal response after ranibizumab IVI (phase 1) and secondary switched to aflibercept (phase 2). The number of follow up visits and IVI were compared in both phases. Visual acuity (VA) evolution and “switching” reasons were secondary analyzed. RESULTS: We retrospectively included data of 33 patients (38 eyes) with age-related macular degeneration (AMD; mean age: 77±7.7y). The number of monthly follow up visits [Median (Q1; Q3)]: was significantly lower with aflibercept (phase 2), respectively 1.0 (0.81; 1.49) visits in phase 1, versus 0.79 (0.67; 0.86) visits in phase 2. The median number of monthly IVI also significantly decreased in phase 2, respectively 0.67 (0.55; 0.90) IVI in phase 1, versus 0.55 (0.45; 0.67) IVI in phase 2. The mean VA evolution (VA final-VA initial) was similar in both phases, (P>0.05). Whatever the reason for “switching” (loss of efficacy, tachyphylaxis, tolerance problems), there was no incidence on VA evolution over the time. CONCLUSION: Our results show that switching from ranibizumab to aflibercept in “suboptimal” patients, significantly reduced the number of follow up visits and IVI, with a comparable efficacy. This decrease in visit number could improve patients’ quality of life and reduce surgical risk by reducing the number of injections.     

Intravitreal aflibercept treatment in eyes with exudative age-related macular degeneration following prior treatment with intravitreal ranibizumab

Background:

To investigate visual and anatomical outcomes in eyes with exudative age-related macular degeneration treated with intravitreal aflibercept following prior treatment with intravitreal ranibizumab.

Materials and Methods:

Retrospective, single-center study of 192 eyes treated with 0.5 mg intravitreal ranibizumab every 4 weeks for three consecutive doses followed by a variable dose schedule. After more than 12 months of ranibizumab treatment, eyes that required ranibizumab injections at 4-week or 6-week intervals were switched to aflibercept therapy.

Results:

After 12–69 months (42 months ± 18 months, mean ± standard deviation [SD]) of treatment with intravitreal ranibizumab, 80 eyes were changed to 2 mg intravitreal aflibercept treatment with follow-up after 12–18 months (16 months ± 1 month, mean ± SD). Thirty-nine eyes had persistent macular fluid after treatment with ranibizumab. Mean logMAR visual acuity (VA) in eyes treated with ranibizumab changed by − 0.089 ± 0.310 (mean ± SD; P = 0.0003), which correlates to an approximate gain of 4.5 letters. The number of eyes with macular fluid decreased from 39 to 23 after aflibercept treatment. Mean logMAR VA in eyes with intraretinal macular fluid treated with aflibercept changed by −0.079 ± 0.134 (mean ± SD; P = 0.006), which correlates to an approximate gain of 4 letters. Mean logMAR VA in eyes with submacular fluid was not significantly different after aflibercept treatment.

Conclusion:

Eyes with persistent intraretinal macular fluid had visual and anatomic response after changing from ranibizumab to aflibercept treatment.