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Cervera, V. Castro, J. Montero, C. Torralba, A. Gracia" "autores" => array:5 [ 0 => array:4 [ "nombre" => "R.E." "apellidos" => "Cervera" "email" => array:1 [ 0 => "Cervera_enr@gva.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "V." "apellidos" => "Castro" ] 2 => array:2 [ "nombre" => "J." "apellidos" => "Montero" ] 3 => array:2 [ "nombre" => "C." "apellidos" => "Torralba" ] 4 => array:2 [ "nombre" => "A." "apellidos" => "Gracia" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Oftalmología, Hospital General Universitario, Valencia, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Experiencia inicial con aflibercept intravítreo en la degeneración macular asociada a la edad exudativa refractaria al tratamiento con ranibizumab o bevacizumab" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 563 "Ancho" => 1500 "Tamanyo" => 111898 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Patient with complete intraretinal fluid resolution after the intravitreal injection of aflibercept. Five previous injections of ranibizumab. (A) Preaflibercept and (B) postaflibercept.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Age-related macular degeneration (ARMD) is the main cause of vision loss in elderly inhabitants of industrialized countries. The most severe visual loss occurs in the wet or exudative form of ARMD. VEGF-inhibiting drugs administered through intravitreal injection, both ranibizumab (Lucentis<span class="elsevierStyleSup">®</span> Genentech, South San Francisco, CA, USA), which was approved for this use, and bevacizumab (Avastin<span class="elsevierStyleSup">®</span>, Genentech, South San Francisco, CA, USA) for compassionate medication, have significantly changed the evolution and visual prognosis of ARMD patients.</p><p id="par0010" class="elsevierStylePara elsevierViewall">In any case it is necessary to find new therapies that provide efficacy rates at least equivalent to the monthly administration of ranibizumab, to reduce both the number of visits and injections.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Aflibercept, a new therapy also known as VEGF-trap, is capable of inhibiting several growth factors. Pivot studies VIEW 1 and 2<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> demonstrated that 2-monthly administration of aflibercept was not inferior to the monthly administration of ranibizumab.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The authors present their initial experience with intravitreal aflibercept (Eylea<span class="elsevierStyleSup">®</span>). The objective of the study was to assess the anatomic and visual effect of a single intravitreal aflibercept injection in exudative ARMD patients.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The authors carried out a retrospective study at the Ophthalmology Service of the General Hospital of Valencia which includes 10 eyes of 10 different patients with a mean age of 79<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>8 years, with a diagnosis of active exudative ARMD despite having received previous treatment with intravitreal ranibizumab or bevacizumab injections (the number of received injections was 6<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>4, ranging between 3 and 15). A sign of activity was considered to be the persistence or recurrence of intra- or subretinal fluid, the presence of new hemorrhages in the fundus and persistent diffusion of the neovascular membrane in intravenous angiofluorescein graph.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The exploration methods applied were best corrected visual acuity (BCVA, ETDRS optotypes) and qualitative and quantitative analysis of images obtained with OCT (OCT 3-D; Topcon Corporation, Tokyo, Japan). The Wilcoxon test for paired non-perimetric variables was applied for statistical purposes, with a value of <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05 being considered as statistically significant.</p><p id="par0035" class="elsevierStylePara elsevierViewall">All the patients received a single aflibercept injection. The mean follow-up time was 37.3<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>5 days. Even though visual improvement was not statistically significant (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.27), up to 30% of patients obtained a visual improvement of one or more lines. In what concerns changes observed by means of OCT, a statistically significant reduction was observed (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.0019) in the foveal thickness (<span class="elsevierStyleItalic">μ</span>), which went from a mean value of 315.7<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>83.5 to 231.7<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>45.6. In addition, a positive anatomic response was found in 100% of patients, with complete resolution (absence of fluid) in 80% of these (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">Accordingly, we are dealing with a new drug for treating exudative ARMD with an action mechanism which is different to that of existing drugs and which, in preliminary studies including the present one has proven to be effective with a single injection for treating refractory cases of the said disease.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Cervera RE, Castro V, Montero J, Torralba C, Gracia A. Experiencia inicial con aflibercept intravítreo en la degeneración macular asociada a la edad exudativa refractaria al tratamiento con ranibizumab o bevacizumab. Arch Soc Esp Oftalmol. 2014;89:42–43.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 563 "Ancho" => 1500 "Tamanyo" => 111898 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Patient with complete intraretinal fluid resolution after the intravitreal injection of aflibercept. Five previous injections of ranibizumab. (A) Preaflibercept and (B) postaflibercept.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "Reference" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:1 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Intravitreal aflibercept (VEGF trap-eye) in wet age-related macular degeneration" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.S. Heier" 1 => "D.M. Brown" 2 => "V. Chong" 3 => "J.F. Korobelnik" 4 => "P.K. Kaiser" 5 => "Q.D. Nguyen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ophtha.2012.09.006" "Revista" => array:6 [ "tituloSerie" => "Ophthalmology" "fecha" => "2012" "volumen" => "119" "paginaInicial" => "2537" "paginaFinal" => "2548" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23084240" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735794/0000008900000001/v1_201404170117/S2173579414000279/v1_201404170117/en/main.assets" "Apartado" => array:4 [ "identificador" => "8723" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735794/0000008900000001/v1_201404170117/S2173579414000279/v1_201404170117/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579414000279?idApp=UINPBA00004N" ]
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Letter to the Editor
Initial experience with aflibercept in the management of patients with wet age-related macular degeneration refractory to ranibizumab and/or bevacizumab
Experiencia inicial con aflibercept intravítreo en la degeneración macular asociada a la edad exudativa refractaria al tratamiento con ranibizumab o bevacizumab
R.E. Cervera
, V. Castro, J. Montero, C. Torralba, A. Gracia
Corresponding author
Servicio de Oftalmología, Hospital General Universitario, Valencia, Spain