Effect of intravitreal aflibercept injection for age-related macular degeneration with a retinal pigment epithelial tear refractory to intravitreal ranibizumab injection

Ayaka Fujii,1 Hisanori Imai,1,2 Michiko Kanai,1 Atsushi Azumi1,2 1Department of Ophthalmology, Kobe Kaisei Hospital, 2Department of Organ Therapeutics, Division of Ophthalmology, Kobe University Graduate School of Medicine, Kobe, Japan Background: The purpose of this study was to evaluate the effects of intravitreal aflibercept injection for age-related macular degeneration (AMD) with a retinal pigment epithelial (RPE) tear after intravitreal ranibizumab injection (IVR) which finally became resistant to additional IVR. Methods: We reviewed the medical records of AMD patients with RPE tears after intravitreal ranibizumab injection who were treated with intravitreal aflibercept injection after acquisition of resistance to additional IVR. Results: One eye from three patients, aged 66, 77, and 78 years, was evaluated. All cases started treatment with IVR for AMD. RPE tear developed 1, 4, and 3 months after the first IVR, respectively. Additional IVR was performed seven, seven, and nine times over 10, 19, and 21 months, respectively, but all cases finally became resistant to IVR. Intravitreal aflibercept injection was performed four times, six times, and once over 8, 9, and 6 months, respectively. At the last visit, all patients had complete resolution of subretinal and intraretinal fluid. Conclusion: Continued intravitreal aflibercept injection may be beneficial to manage AMD with RPE tear which has become resistant to additional IVR. Keywords: aflibercept, ranibizumab, retinal pigment epithelial tear, age-related macular degeneratio