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Takeya Kohno, Manabu Yamamoto, Akira Cho, Yusaku Yoshida, Hisashi Iwami, Yuta Sawa, Kumiko Yoshimoto, Michiko Hirabayashi, Kunihiko Shiraki; Six-month results of switching to aflibercept for polypoidal choroidal vasculopathy in patients refractory to ranibizumab. Invest. Ophthalmol. Vis. Sci. 2014;55(13):3839.
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The aim of this study was to examine the short-term efficacy of intravitreal injections of aflibercept (IVA) in patients with polypoidal choroidal vasculopathy (PCV) refractory to ranibizumab (IVR).
Eight eyes of consecutive 8 patients, who were treated previously with IVR with or without photodynamic therapy (PDT) more than one year but failed to resolve subretinal fluid (SRF), were reviewed. Loading treatment of IVA was composed of three monthly injections and additional monthly injections until disappearance of SRF on optical coherence tomography (OCT). After the resolution of SRF, IVA injections were done bimonthly.
The follow-up periods of IVR before switching to IVA ranged from 15 to 47 months (mean, 29.1±13.8) and the number of IVR injections ranged from 11 to 37 (mean,16.3±8.6). The mean decimal visual acuity was 0.73±0.15 at baseline (range, 0.3-1.5), 0.85±0.35 at month 3 (p=0.04) and 0.89±0.39 at month 6 (p=0.04). The mean foveal thickness was 257.4±51.3 µm (range, 182-318) at baseline, 172.4±25.7 µm (range, 151-218) at month 3 (p=0.02) and 213.0±71.1µm (range, 158-347) at month 6 (p=0.12). The number of IVA injections before obtaining complete resolution of SRF was three in 6 eyes, four in one eye and five in one eye. SRF was absent and pigment epithelial detachment (PED) was decreased 1 month after the last injection of the initial monthly injections of IVA. However, SRF recurrence and PED increase were noted on OCT during the subsequent periods of bimonthly IVA injections in 6 of 8 eyes.
The switching to IVA for PCV refractory to IVR therapy improved or maintained the visual acuity for 6 months. However, the disease activity of PCV did remain even after SRF resolution and PED improvement had been obtained with the loading IVA injections and recurrence did occur at subsequent 2-month intervals of IVA injections.
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