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Mihai Mititelu, Dilraj Grewal, Daniel Sarezky, Rukhsana Mirza, Manjot Gill, Alice Lyon; Quantitative Optical Coherence Tomography Analysis Of Change in Pigment Epithelial Detachment Morphology Following Intravitreal Aflibercept Injection In Eyes With Recalcitrant Neovascular Age-Related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2013;54(15):4148.
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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.
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.
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.
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.
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