Natalia Zhaivoronok, L.P. Danilova, Russian Federation

Purpose:
To evaluate the clinical efficacy of the combined use of aflibercept and meldonium in tachyphylaxis of neovascular Age-related Macular Degeneration (nAMD) to ranibizumab.

Materials:
A comparative analysis of nAMD treatment results in 25 eyes (25 patients) aged from 52 to 79 (mean age 68.3±2.5) years, 17 women and 8 men was carried out. The main criterion for inclusion in the study was the resistance patients with nAMD to the intravitreal introduction of VEGF inhibitor ranibizumab and the visual acuity not lower than 0.1. All patients’ eyes were divided into two groups comparable by sex, age, visual acuity and type of CNV (13 patients – the main group, 12 patients – the comparison group). Patients of both groups were given 3 consecutive loading intravitreal introduction of aflibercept (IVIA) 2.0 mg (0.05 ml) once a month. In the main group, 3-fold IVIA was supplemented with parabulbar injections of 0.5 ml of meldonium solution (with a concentration of 500 mg / 5 ml) daily for 10 days.

Results:
Analysis of the obtained data showed that before the introduction of aflibercept, the functional indicators were reduced and according to their average, had no significant intergroup differences (p> 0.05) in comparison with the control. By the final stage of the survey in patients of the main group who additionally received the cytoprotector meldonium, the average functional parameters increased compared to the baseline: MCVA – 2.6 times; ÐœS – 2.1 times, and the amplitude of the β-wave of the total ERG – 1.4 times. Positive functional dynamics was due to a stable regression of CNV with the formation of a small avascular proliferative membrane. Compared to the main group, the comparison group showed a 1.2-fold decrease in choroid thickness and neuroepithelial thickness 6 months after the last aflibercept injection. In 3 patients, in the irregularly shaped proliferative membrane, there were small single vessels, representing a risk for the resumption of CNV growth and the appearance of an exudative-hemorrhagic component, and they also showed a decrease in MCVA by 0.05-0.1 due to an increase in the macula of the chorioretinal atrophy zone.

Conclusions:
The findings suggest the clinical feasibility of additional use of a course treatment with meldonium at intravitreal introduction of aflibercept in patients with nAMD resistant to ranibizumab for increasing visual function and stabilizing the degenerative changes of the neurosensory retina, choriocapillary layer.

Contact Details:
Natalia Zhaivoronok
S.N. Fyodorov’s Eye Microsurgery Complex
Khabarovsk
Russian Federation
Cell Phone : +74212722792
Work Phone : +7-4212-72-27-92
Email : naukakhvmntk@mail.ru