Abstract
Purpose:
To quantitatively evaluate the change in Pigment Epithelial Detachment (PED) morphology on SD-OCT following intravitreal aflibercept (2mg/0.05ml) in patients with neovascular age-related macular degeneration (AMD) who had persistent disease activity recalcitrant to prior monthly intravitreal bevacizumab or ranibizumab.
Methods:
Retrospective chart review of patients with neovascular AMD (treated with ≥6 prior intravitreal 0.5 mg/0.05 ml ranibizumab or 1.25 mg/0.05 ml bevacizumab injections in the previous 12 months) who had a persistent fibrovascular or serous PED on SD-OCT. The greatest basal diameter (GBD) and maximum height (MH) (μm) of the largest PED on SD-OCT were calculated using the software manual caliper measurement tool at baseline and following 6 months of intravitreal aflibercept. Each PED was also subjectively classified as hypo, hyper or mixed-reflectivity.
Results:
Twenty-six eyes of 23 patients (11 males, 12 females; mean age 79.3 ± 5.6 years) who had received an average of 26.9 ± 16.6 (range 6-70) prior ranibizumab or bevacizumab injections over 30.7 ± 18.4 months were included. Mean baseline BCVA was 0.33 ± 0.28 logMAR (range 0-0.9). Mean PED GBD was 1836.3±1056.6 μm (range 457-4392 μm) and mean MH was 239.8±166.9 μm (78-635 μm). At 6 months follow-up, mean BCVA was 0.31 ± 0.26 logMAR (range 0-0.83, p=0.5). Mean PED GBD significantly improved to 1687±1011.3 μm (range 469-4470 μm, p=0.016), while MH significantly decreased to 209.6±136.3 μm (range 64-510 μm, p=0.003). The reduction in PED MH positively correlated with baseline PED MH (r=0.64, p=0.001) and baseline PED GBD (r=0.67, p<0.001). At baseline, 19/26 eyes had associated subretinal fluid (SRF) while 10/26 had intraretinal fluid (IRF). At 6 months, 10/26 eyes had residual SRF (p=0.07) and 3/26 eyes had IRF (p=0.02). The PED reflectivity remained unchanged, being hypo-reflective in 10 eyes, hyper-reflective in 3 eyes and of mixed-reflectivity in 13 eyes at baseline, and at 6 months.
Conclusions:
In previously treated eyes with recalcitrant neovascular AMD and a concurrent PED, aflibercept led to statistically significant anatomic improvement in PED dimensions, while not affecting the PED reflectivity. Aflibercept may be an effective alternative in these difficult to manage cases.
Keywords: 412 age-related macular degeneration •
748 vascular endothelial growth factor •
701 retinal pigment epithelium