Case Study

Switching Therapy to Improve Response

By Rishi P. Singh, MD

In this case study, a 74-year-old patient who had received four prior ranibizumab (Lucentis, Genentech) injections was enrolled in a prospective clinical trial evaluating the use of aflibercept (Eylea, Regeneron) for patients on previous anti-VEGF therapies. Upon enrollment, visual acuity was 20/160, and OCT showed pigment epithelial detachment of the intraretinal and cystoid edema of the central fovea. The angiogram confirmed the activity of the lesion, with some subretinal hemorrhage present.

The patient was administered three upfront injections of aflibercept in months 0, 1, and 2, and given injections every 2 months thereafter. The Figure below shows the baseline VA at 20/160, which improved to 20/80 after 1 month of therapy, and continued to improve up to month 6, to 20/63.

At month 6, a significant resolution of pigment epithelial detachment was observed, with no evidence of cystoid edema, and trace amounts of intraretinal fluid present. The patient gained 24 letters in VA from baseline.

Figure 1. Visual acuity, as measured over duration of treatment.