Intravitreal Aflibercept Application in Patients with Type 1 Choroidal Neovascular Membrane Resistant to Ranibizumab Treatment Results

Year 2022, , 150 - 157, 31.08.2022

Işıl Merve Torun , Erkan Duman , Nursel Melda Yenerel

https://doi.org/10.29058/mjwbs.1022336

Abstract

Aim: To research efficacy of intravitreal aflibercept injection treatment in patients who are resistant to ranibizumab treatment and having
type 1 choroidal neovascular membranes.
Material and Methods: Twenty four eyes of 22 patients having neovascular age related macular degeneration (AMD) diagnosed as type 1
choroidal neovascular membrane were identified by optical coherence tomography (OCT) and fundus fluorescein angiography at Haydarpasa
Numune Research and Training Hospital between Dec’12 and Jan’16 and were analyzed retrospectively. Baseline and post-ranibizumab
treatment of best-corrected visual acuity (BCVA), fundus findings and central retinal thickness with OCT of patients were recorded. In order
to assess efficacy of intravitreal aflibercept treatment the mean numbers of injections, BCVA and the mean central retinal thickness were
statistically compared with baseline and post- treatment figures. NCSS program (Number Cruncher Statistical System) 2007 (Kaysville,
Utah, USA) was used for statistical analysis. Descriptive analyses were presented using means and standard deviations for normally
distributed variables. The Mann Whitney U test was used for the comparison of the quantitative data and the comparison of the parameters
that did not show normal distribution between the two groups. Kruskal Wallis test was used for comparisons of groups of three or more that
did not show normal distribution. Wilcoxon Signed Ranks test was used for in-group comparisons of parameters that did not show normal
distribution. Significance was evaluated at p<0.05 levels.
Results: The mean follow-up time was 35.32±13.36 months. The mean central retinal thickness decreased 80.25±76.32 μm as a result of
aflibercept treatment compared to ranibizumab treatment and the outcomes were statistically significant (p=0.001; p<0.01). No significant
difference was observed in BCVA between aflibercept and ranibizumab treatment (p>0.05). No significant difference was observed with
respect to the location of retinal fluid or existence of PED in the efficacy of aflibercept (p>0.05).
Conclusion: Anatomic improvement was confirmed in all patients who were resistant to ranibizumab. Retinal fluid location and existence of
PED may not be a decisive factor at efficacy of aflibercept in patients resistant to ranibizumab.

Keywords

aflibercept, age-related macular degeneration, best corrected visual acuity, ranibizumab, type 1 choroidal neovascularization

Ranibizumab Tedavisine Dirençli Tip 1 Koroidal Neovasküler Membranlı Olgularda İntravitreal Aflibercept Uygulaması Sonuçlarımız

Abstract

Amaç: Ranibizumab tedavisine dirençli tip 1 koroidal neovasküler membranlı olgularda intravitreal
aflibercept tedavisinin etkinliğini araştırmak.
Gereç ve Yöntemler: Haydarpaşa Numune Eğitim ve Araştırma Hastanesi Göz Kliniği’ne Aralık 2012-
Ocak 2016 tarihleri arasında başvurup, neovasküler tip yaşa bağlı makula dejenerasyonu (YBMD)
tanısı alan, optik koherens tomografi (OKT) ve fundus floresein anjiografi (FFA) ile tip 1 koroidal
neovasküler membranı (KNV) olduğu tespit edilen 22 hastanın 24 gözü geriye dönük olarak incelendi.
Olguların ilk başvurularındaki ve ranibizumab tedavisi sonrasındaki en iyi düzeltilmiş görme keskinlikleri
(EİDGK), fundus muayene bulguları ve OKT ile yapılan makula kalınlığı ölçümleri kaydedildi. İntravitreal
aflibercept tedavisinin etkinliğini değerlendirmek için tedavi öncesi ve sonrasındaki EİDGK’leri, ortalama
enjeksiyon sayıları ve ortalama makula kalınlıkları istatistiksel olarak karşılaştırıldı. İstatistiksel analizler
için NCSS (Number Cruncher Statistical System) 2007 (Kaysville, Utah, USA) programı kullanıldı.
Çalışma verileri değerlendirilirken tanımlayıcı istatistiksel metodların (Ortalama, Standart Sapma,
Medyan, Frekans, Oran, Minimum, Maksimum) yanı sıra; niceliksel verilerin karşılaştırılmasında normal
dağılım göstermeyen parametrelerin iki grup karşılaştırmalarında ise Mann Whitney U testi kullanıldı.
Normal dağılım göstermeyen üç ve üzeri grupların karşılaştırmalarında ise Kruskal Wallis test kullanıldı.
Normal dağılım göstermeyen parametrelerin grup içi karşılaştırmalarında ise Wilcoxon Signed Ranks
test kullanıldı. Anlamlılık p<0.05 düzeylerinde değerlendirildi.
Bulgular: Olgular kliniğe ilk başvurudan itibaren ortalama 35,32±13,36 ay takip edildi. Ranibizumab
tedavisi sonrası ortalama makula kalınlığı ölçümlerine göre aflibercept tedavisi sonrası ortalama makula
kalınlığı ölçümlerinde 80,25±76,32 μm’luk düşüş saptandı ve istatistiksel olarak anlamlı bulundu.
(p=0,001; p<0,01) Ranibizumab tedavisi sonrası EİDGK ölçümleri ile aflibercept tedavisi sonrası EİDGK
ölçümleri arasında istatistiksel olarak anlamlı bir farklılık saptanmadı. (p>0,05) Retinal sıvının lokasyonuna
göre (subretinal, intraretinal, her ikisi birden ya da kistoid dejenerasyon) ya da pigment epitel
dekolmanı (PED) mevcudiyetine göre aflibercept tedavisi başarısında anlamlı bir farklılık görülmedi
(p>0,05).
Sonuç: Çalışmamızda ranibizumab tedavisine dirençli neovasküler YBMD’nin intravitreal aflibercept
enjeksiyonu ile tedavisinde anatomik iyileşme sağlandı. Retinadaki sıvı lokasyonunun, PED
mevcudiyetinin, tedaviye dirençli vakalarda aflibercept etkinliğinde belirleyici faktör olmayabileceği
düşünüldü.

Keywords

aflibercept, görme keskinliği, ranibizumab, tip 1 koroid vaskülarizasyonu, yaşa bağlı makula dejenerasyonu

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