Course of Neovascular Age-related Macular Degeneration that Showed Limited Response to Both Ranibizumab and Aflibercept

Purpose: To evaluate the clinical course of neovascular age-related macular degeneration (nAMD) that has shown limited re-sponse to ranibizumab and aflibercept. Methods: This retrospective study included 14 eyes with nAMD that showed a limited response to initial treatment using ranibizu-mab and aflibercept. The changes in visual acuity (VA) during the follow-up period and the incidence and timing of VA deterio-ration to the level of 0.1 or worse were identified. In cases involving bevacizumab treatment, the follow-up duration and the pro-portion of patients maintaining a VA of 0.2 or better were identified. Results: During the mean 43.3 +/- 33.2 months of follow-up, the VA deteriorated significantly from a mean logarithm of minimum angle of resolution (logMAR) of 0.42 +/- 0.34 at diagnosis to 0.91 +/- 0.68 at the final follow-up (p = 0.021). A logMAR of 0.3 or great-er degree of VA deterioration was noted in six eyes (42.9%). Among the 13 eyes exhibiting a VA of 0.2 or better after the initial treatment, a deterioration to a VA of 0.1 or worse was noted in 6 eyes (46.2%) at a mean 29.7 +/- 18.3 months. In eight eyes under-going bevacizumab treatment, four eyes (50.0%) maintained 0.2 or better VA during the 51.4 +/- 35.5 months of follow-up. Conclusions: The clinical course of patients with limited response to ranibizumab and aflibercept was generally unfavorable. However, a relatively long period was required for the deterioration in VA to reach 0.1 or worse. In addition, 0.2 or better VA was maintained in approximately half of the patients. J Korean Ophthalmol Soc 2023;64(4):313-322