@article {1363231, title = {Conversion to aflibercept for chronic refractory or recurrent neovascular age-related macular degeneration}, journal = {Am J Ophthalmol}, volume = {156}, number = {1}, year = {2013}, month = {2013 Jul}, pages = {29-35.e2}, abstract = {PURPOSE: To explore the visual and anatomic outcomes of patients with refractory or recurrent neovascular age-related macular degeneration (AMD) who were converted from bevacizumab and/or ranibizumab to aflibercept. DESIGN: Two-center, retrospective chart review. METHODS: Treatment history, visual acuity (VA), and central macular thickness (CMT) on spectral-domain optical coherence tomography were collected. Patients were divided into "refractory" (persistent exudation despite monthly injections) or "recurrent" (exudation suppressed, but requiring frequent injections). RESULTS: One hundred and two eyes of 94 patients were included; 68 were refractory and 34 were recurrent. Eyes received a mean of 20.4 prior bevacizumab/ranibizumab injections and a mean of 3.8 aflibercept injections. Mean follow-up was 18\ weeks. Mean VA was 20/50-1 before conversion, 20/50-2 after 1 aflibercept injection (P\ = .723), and 20/50+2 after the final injection (P\ = .253). Subgroup analysis of refractory and recurrent cases also showed stable VA. Of the refractory cases, mean CMT had improved after 1 injection (P \< .001) and the final injection (P \< .001). Intraretinal (P\ \<\ .001) and subretinal (P \< .001) fluid decreased after 1 injection, and the mean injection interval was extended from 5.2 to 6.2\ weeks (P\ = .003). Of the recurrent cases, mean CMT improved after 1 injection (P\ \<\ .001) and the final injection (P \< .001). Intraretinal (P\ = .003) and subretinal (P\ = .046) fluid decreased after 1 injection, and the mean injection interval was extended from 7.2 to 9.5\ weeks (P\ = .001). CONCLUSIONS: Converting patients with chronic neovascular AMD to aflibercept results in stabilized vision and improved anatomic outcomes, while allowing injection intervals to be extended.}, keywords = {Aged, Aged, 80 and over, Angiogenesis Inhibitors, Antibodies, Monoclonal, Humanized, Bevacizumab, Chronic Disease, Drug Substitution, Drug Therapy, Combination, Female, Humans, Intravitreal Injections, Male, Middle Aged, Ranibizumab, Receptors, Vascular Endothelial Growth Factor, Recombinant Fusion Proteins, Recurrence, Retrospective Studies, Tomography, Optical Coherence, Vascular Endothelial Growth Factor A, Visual Acuity, Wet Macular Degeneration}, issn = {1879-1891}, doi = {10.1016/j.ajo.2013.03.030}, author = {Yonekawa, Yoshihiro and Andreoli, Christopher and Miller, John B and Loewenstein, John I and Sobrin, Lucia and Eliott, Dean and Vavvas, Demetrios G and Miller, Joan W and Kim, Ivana K} }