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One-year outcome of intravitreal ziv-aflibercept therapy for non-responsive neovascular age-related macular degeneration
  1. Imoro Zeba Braimah1,2,
  2. Komal Agarwal2,
  3. Ahmad Mansour3,4,
  4. Jay Chhablani2
  5. on behalf of Ziv-aflibercept Study Group
  1. 1 School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Accra, Ghana
  2. 2 Srimati Kanuri Santhamma Centre for Vitreo Retinal Diseases, KAR Campus, L V Prasad Eye Institute, Hyderabad, Telangana, India
  3. 3 Department of Ophthalmology, American University of Beirut, Beirut, Lebanon
  4. 4 Department of Ophthalmology, Rafic Hariri University Hospital, Beirut, Lebanon
  1. Correspondence to Dr Jay Chhablani, LV Prasad Eye Institute, Banjara Hills, Road no. 2 Hyderabad 500034, India; jay.chhablani{at}


Aim To evaluate 12-month outcome of intravitreal ziv-aflibercept (IVZ) therapy in eyes with neovascular age-related macular degeneration (nAMD) that are non-responsive to bevacizumab and ranibizumab.

Methods This retrospective study included 16 eyes (14 patients) with nAMD who were on prior treatment with bevacizumab and ranibizumab and were treated with as-needed IVZ (1.25 mg/0.05 mL) for 12 months. The primary outcome measure was the mean change in best corrected visual acuity (BCVA) and secondary outcome measures included mean change in central macular thickness (CMT), retinal pigment epithelial detachment (RPED) heights, longest treatment free interval, presence of subretinal fluid (SRF) and intraretinal fluid (IRF) and adverse events.

Results There was no change in the mean logarithm of minimum angle of resolution (logMAR) BCVA at baseline and following treatment with IVZ therapy (p=0.978). The mean number of IVZ injections during 12 months was 5.9±3.3, and the mean number of antivascular endothelial growth factors (VEGFs) injections prior to switching to IVZ was 8.4±4.7. The mean treatment free interval was longer during IVZ therapy (114.4±67.1 days) compared with 76.3±54.6 days before IVZ therapy (p=0.03). Five (31.25%) eyes had visual gains of at least 0.1 logMAR, 3 (18.75%) eyes had stable BCVA (within 0.1 logMAR) and 8 (50%) eyes had BCVA decline of at least 0.1 logMAR. There was no significant difference in the mean CMT, RPED heights and presence of IRF and SRF at 12 months compared with baseline. No adverse events were noted.

Conclusion IVZ increased the treatment free interval in non-responders but no significant change in visual and anatomic outcomes.

  • Ziv-aflibercept
  • Aflibercept
  • Bevacizumab
  • Ranibizumab
  • Anti-VEGF
  • AMD
  • Choroidal neovascularization

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  • Contributors Design of the study (JC and KA) and conducted the study (KA, AM and JC); collection (KA, AM and CD), management (JC, AM and KA), analysis (IZB and JC) and interpretation of the data (IZB, JC and AM); and preparation (IZB, JC, KA and AM), review (IZB, JC, KA and AM) or approval (IZB, JC, KA and AM) of the manuscript.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval L V Prasad Eye Institute.

  • Provenance and peer review Not commissioned; externally peer reviewed.