OUTCOME OF INTRAVITREAL AFLIBERCEPT FOR REFRACTORY PIGMENT EPITHELIAL DETACHMENT WITH OR WITHOUT SUBRETINAL FLUID AND SECONDARY TO AGE-RELATED MACULAR DEGENERATION.

Abstract

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) significantly reduced to 0.23 ± 0.32 mm at Week 8 (P = 0.003) and increased to 0.36 ± 0.41 mm at Week 48 (P = 0.345). The SRF volume (baseline: 0.52 ± 0.64 mm) significantly reduced to 0.24 ± 0.43 mm 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 μm; it significantly reduced to 281.2 ± 90.7 μm 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.

• Authors: Kiyoung Kim, Eung Suk Kim, Yonguk Kim, Ji Ho Yang, Seung-Young Yu, Hyung Woo Kwak
• Journal: Retina (Philadelphia, Pa.) (Retina) Vol. 39 Issue 2 Pg. 303-313 (Feb 2019) ISSN: 1539-2864 [Electronic] United States
• PMID: 29160779 (Publication Type: Journal Article)

Chemical References

• Recombinant Fusion Proteins
• Vascular Endothelial Growth Factor A
• aflibercept
• Receptors, Vascular Endothelial Growth Factor

Topics

• Aged
• Female
• Follow-Up Studies
• Humans
• Intravitreal Injections
• Macular Degeneration (complications, diagnosis, drug therapy)
• Male
• Prospective Studies
• Receptors, Vascular Endothelial Growth Factor (administration & dosage)
• Recombinant Fusion Proteins (administration & dosage)
• Retinal Detachment (diagnosis, drug therapy, etiology)
• Retinal Pigment Epithelium (pathology)
• Subretinal Fluid (diagnostic imaging)
• Tomography, Optical Coherence (methods)
• Treatment Outcome
• Vascular Endothelial Growth Factor A (antagonists & inhibitors)
• Visual Acuity