optimization of therapy against vascular endothelial growth factor for patients suffering from age-related macular degeneration

This study evaluates the efficacy of aflibercept in patients with wet age-related macular degeneration who developed resistance to ranibizumab after multiple intravitreal administrations. a retrospective analysis of 36 patients was conducted. initially, all participants received ranibizumab treatment and responded well during the loading phase, with three consecutive monthly injections improving visual acuity and reducing macular fluid, as assessed by optical coherence tomography (oct). however, after more than 15 injections, all patients developed resistance, evidenced by disease recurrence with decreased visual acuity and persistent fluid accumulation. the cohort was divided into two groups: group 1 (experimental) included 20 patients who switched to monthly aflibercept loading doses, while group 2 (control) consisted of 16 patients continuing ranibizumab therapy. injections were administered in a sterile operating room following standard protocols. in group 1, switching to aflibercept resulted in significant improvements, including a mean retinal thickness reduction of 104 µm (from 342.9±44.6 µm to 238.8 ± 18.0 µm, p<0.05) and an increase in maximum corrected visual acuity from 0.44±0.1 to 0.71±0.01 (p<0.05) after three loading doses. group 2 showed no significant improvement, with persistent macular edema (mean thickness 301.3±19.0 µm) and declining visual acuity (0.38±0.07). these findings position aflibercept as a promising alternative for ranibizumab-resistant cases of exudative age-related macular degeneration. initial ranibizumab therapy effectively resorbed exudative contents, but resistance emerged after extended use (>15 injections), leading to retinal edema unresponsive to further ranibizumab. switching to aflibercept yielded a pronounced positive trend, alleviating macular edema and improving visual outcomes.