%0 Journal Article %J Am J Ophthalmol %D 2013 %T Conversion to aflibercept for chronic refractory or recurrent neovascular age-related macular degeneration %A Yonekawa, Yoshihiro %A Andreoli, Christopher %A Miller, John B %A Loewenstein, John I %A Sobrin, Lucia %A Eliott, Dean %A Vavvas, Demetrios G %A Miller, Joan W %A Kim, Ivana K %K Aged %K Aged, 80 and over %K Angiogenesis Inhibitors %K Antibodies, Monoclonal, Humanized %K Bevacizumab %K Chronic Disease %K Drug Substitution %K Drug Therapy, Combination %K Female %K Humans %K Intravitreal Injections %K Male %K Middle Aged %K Ranibizumab %K Receptors, Vascular Endothelial Growth Factor %K Recombinant Fusion Proteins %K Recurrence %K Retrospective Studies %K Tomography, Optical Coherence %K Vascular Endothelial Growth Factor A %K Visual Acuity %K Wet Macular Degeneration %X 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. %B Am J Ophthalmol %V 156 %P 29-35.e2 %8 2013 Jul %G eng %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/23668679?dopt=Abstract %R 10.1016/j.ajo.2013.03.030