OUTCOME OF INTRAVITREAL AFLIBERCEPT FOR REFRACTORY PIGMENT EPITHELIAL DETACHMENT WITH OR WITHOUT SUBRETINAL FLUID AND SECONDARY TO AGE-RELATED MACULAR DEGENERATION KIYOUNG KIM, MD,* EUNG SUK KIM, MD, PHD,* YONGUK KIM, MD,* JI HO YANG, MD,† SEUNG-YOUNG YU, MD, PHD,* HYUNG WOO KWAK, MD, PHD* Purpose: To investigate the outcomes of intravitreal aflibercept in refractory pigment epithelial detachment (PED) with or without subretinal fluid (SRF) in patients with neovascular age-related macular degeneration. Methods: A prospective, nonrandomized, interventional case series involved 40 patients with persistent vascularized PED previously treated with at least 3 injections of intravitreal bevacizumab or ranibizumab. Intravitreal aflibercept was administered as 3 initial loading doses every 4 weeks, followed by pro re nata retreatment every 8 weeks over 48 weeks. Pigment epithelial detachment was classified into solid-, hollow-, or mixed-type according to the reflective properties visualized using optical coherence tomography. The mean changes in best-corrected visual acuity, central subfield thickness, and the volumes of SRF and PED were analyzed. Results: The PED volume (baseline: 0.43 ± 0.55 mm 3 ) significantly reduced to 0.23 ± 0.32 mm 3 at Week 8 (P = 0.003) and increased to 0.36 ± 0.41 mm 3 at Week 48 (P = 0.345). The SRF volume (baseline: 0.52 ± 0.64 mm 3 ) significantly reduced to 0.24 ± 0.43 mm 3 at Week 48 (P = 0.021). The mean baseline best-corrected visual acuity was 20/75 (47.5 letters); it showed no significant difference at Week 48 (+4.4 letters; P = 0.125). The baseline central subfield thickness was 323.2 ± 92.3 mm; it significantly reduced to 281.2 ± 90.7 mm at Week 48 (P = 0.001). In solid-type PEDs, there were poorer improvements in central subfield thickness, best-corrected visual acuity, and the volumes of the SRF and PED, with newly developed intraretinal cysts. Conclusion: Intravitreal aflibercept in treatment-resistant neovascular age-related macular degeneration led to significant reduction in PED and SRF volume, central subfield thickness, and best-corrected visual acuity preserved, over 12 months. However, solid- type PED showed less improvement than hollow- or mixed-type PED. RETINA 0:1–11, 2017 N eovascular age-related macular degeneration (nAMD) is a leading cause of visual loss and blind- ness in the aged population. 1 The efficacy of intravitreal anti–vascular endothelial growth factor (VEGF) in the treatment of subfoveal choroidal neovascularization (CNV) secondary to nAMD has been well established in several recent clinical trials. 2–4 However, despite these encouraging results, the SEVEN-UP and CATT studies showed that 68% and 51.5% of patients, respectively, require continued monthly injections to treat recurrent exudation. 5,6 In addition, a number of recent studies have reported that pigment epithelial detachment (PED) is a poor prognostic factor after anti-VEGF treatment for AMD and that a significant proportion of patients shows suboptimal response or develops resistance and tachy- phylaxis over time. 5–8 Aflibercept (Eylea; Regeneron, Tarrytown, NY) is an anti-VEGF agent with a higher binding affinity than 1 Copyright ª by Ophthalmic Communications Society, Inc. Unauthorized reproduction of this article is prohibited.