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Choroidal neovascularization (CNV) secondary to angioid streaks (AS) is a cause of important vision loss. The use of antivascular endothelial growth factors to treat CNV due to AS is well described.
The aim of our study was to evaluate the efficacy of switching from intravitreal Ranibizumab to intravitreal Aflibercept in choroidal neovascularization (CNV) secondary to angioid streaks (AS).
Retrospective and monocentric study including 9 eyes of 5 patients previously treated with intravitreal Ranibizumab (IVTR) with at least 12-month follow-up (M12) after switching (M0) to intravitreal Aflibercept (IVTA). Switch to intravitreal Aflibercept was decided in cases of refractory or recurrent CNV. Change of best-corrected visual acuity (BCVA) was evaluated using the Early Treatment Diabetic Retinopathy Study letters (ETDRS). We observed the mean change of central macular thickness (CMT), absence of intraretinal/subretinal fluid on spectral domain optical coherence tomography (SD-OCT) and the percentage of eyes with absence of leakage on fluorescein angiography (FA).
Nine eyes of 5 patients were included (3 males and 2 females). Mean age was 48.2 ± 7.6 years. The study period before switch was 69.7±50.1months (range 23–183). During the year before the switch, the mean IVTR was 6.5±3.3 (range 4–11). The mean number of IVTA after switch was 5.6±1.70 (range 3–10). Mean BCVA was 55.0 ± 13.04 letters at M0 and 65.0 ± 27.50 letters at M12. BCVA was “stabilized” in 6 out of 9 eyes (66%) (three patients), “improved” in 2 out of 9 eyes (22%) (one patient), and “worsened” in 1 out of 9 eyes (14%) (one patient). Mean CMT was 356 ± 178.67 µm at M0 and 272± 80.12 µm at M12 (p<0.01). FA was performed at M0 in 8 eyes (4 patients) and showed leakage from active CNV in all cases. At M12, FA showed absence of leakage in six eyes. Absence of intraretinal/subretinal fluid was observed in 6 eyes on SD-OCT.
The successful results of switching to intravitreal Aflibercept in the treatment of CNV associated with AMD suggested to use this anti-VEGF also for the management of CNV secondary to AS previously treated with other anti-VEGF, as a limited knowledge on efficacy restrict to a few clinical reports are available. In the current study, we observed that switching from intravitreal Ranibizumab to intravitreal Aflibercept may be beneficial in stabilizing BVCA and decreasing CMT in patients with CNV secondary to AS.
In our series, switching from intravitreal Ranibizumab to intravitreal aflibercept represents a therapeutic option in patients with refractory or recurrent CNV secondary to AS.