Switch to Aflibercept After Chronic Treatment With Bevacizumab for Choroidal Neovascularization With Age-Related Macular Degeneration

Purpose: To present the 5-year anatomic and functional outcomes in patients with choroidal neovascularization (CNV) and age-related macular degeneration (AMD) and determine whether late-onset intensification of treatment results in improved outcomes. Methods: This retrospective interventional study analyzed spectral-domain optical coherence tomography data and visual acuity (VA) in eyes in which treatment intensification was implemented after a mean of 39 months. Data collected included age, sex, injection frequency, central retinal thickness, type of CNV, and VA. Patients were evaluated every 4 to 10 weeks, depending on the disease activity. Results: Fifty eyes of 50 patients with CNV were evaluated. The mean initial VA was 0.37 Snellen (0.58 logMAR), which improved to 0.44 Snellen (0.47 logMAR) after the first bevacizumab injection. Six months after bevacizumab was switched to aflibercept, the improvement in VA was significant in all groups (P < .05). The VA improved throughout the 6-year observation period, with the greatest improvement in VA after the switch in patients who received the most injections (P < .05), who had the best initial VA (P < .05), and who experienced a significantly greater improvement in VA after the first bevacizumab injection (P = .01). Conclusions: Increasing the treatment frequency, even after several years of treatment, improved visual outcomes in patients with CNV and AMD who switched from bevacizumab to aflibercept.