International Ophthalmology

, Volume 39, Issue 11, pp 2441–2448 | Cite as

Indocyanine green angiography findings in patients with neovascular age-related macular degeneration refractory to ranibizumab switched to aflibercept

  • Cristina Calvo-GonzalezEmail author
  • Juan Reche-Frutos
  • José Ignacio Fernández-Vigo
  • Juan Donate-López
  • Irene Serrano-García
  • Cristina Fernández-Pérez
Original Paper



To describe indocyanine green angiography (ICGA) and visual acuity (VA) results in patients with neovascular age-related macular degeneration (nAMD) refractory to ranibizumab switched to aflibercept.


This study is a prospective interventional case series. Thirty-two eyes of 32 patients with nAMD showing a poor response after at least 24 months of ranibizumab were switched to aflibercept. Twenty eyes had type I choroidal neovascularization (CNV group), and 12 eyes had polypoidal choroidal vasculopathy (PCV group). After an initial loading dose of three monthly aflibercept injections, treatment was continued on a treat-and-extend basis. ICGA was performed just before the first aflibercept injection (baseline) and 12 and 24 months later. The variables recorded were: closure of polyps and lesion area, VA, number of aflibercept injections, dry macula, and pigment epithelium detachment.


The following means were recorded in the CNV and PCV groups, respectively: number of ranibizumab injections 20.4 ± 11.2 and 22.4 ± 12.9 (p = 0.740); baseline VA (before aflibercept) 73.2 ± 9.1 and 70.3 ± 13.7 letters (p = 0.654); and final VA 73.0 ± 7.6 and 69.3 ± 15.6 letters (p = 0.509). VA remained stable (p = 0.761 and 0.964) after 15.5 ± 3 and 15.1 ± 3.5 aflibercept injections (p = 0.244). At 24 months, dry macula was noted in 40 to 50% of the eyes (p = 0.620). Complete resolution of polyps was observed in 58% at 12 months and 92% at 24 months.


In patients with nAMD refractory to ranibizumab, aflibercept was effective at maintaining VA and closing numerous polyps. In half of the patients, dry macula was observed at 24 months.


Indocyanine green angiography Polypoidal choroidal vasculopathy Age-related macular degeneration Ranibizumab Poor responders Aflibercept 


Compliance with ethical standards

Conflicts of interest

There are no known conflicts of interest by the authors associated with this publication.


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Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  • Cristina Calvo-Gonzalez
    • 1
    Email author
  • Juan Reche-Frutos
    • 1
  • José Ignacio Fernández-Vigo
    • 1
  • Juan Donate-López
    • 1
  • Irene Serrano-García
    • 2
  • Cristina Fernández-Pérez
    • 2
  1. 1.Department of OphthalmologyHospital Universitario Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC)MadridSpain
  2. 2.Department of Preventive MedicineHospital Universitario Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC)MadridSpain

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