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Thomas Hong, Geoffrey Broadhead, Meidong Zhu, Haitao Li, Timothy Schlub, Wijeyanthy Wijeyakumar, Andrew Alexander Chang; Response of Pigment Epithelial Detachments following Intravitreal Aflibercept for Age-Related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2014;55(13):3937.
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To assess the response of pigment epithelial detachments (PEDs) to intravitreal aflibercept in patients with refractory neo-vascular age-related macular degeneration (nAMD) over 12 months.
43 patients with PED participating in a prospective trial for nAMD received 3 loading injections of intravitreal aflibercept 4 weeks apart followed by injections every 8 weeks across 48 weeks. All patients underwent monthly ophthalmic examination including best-corrected visual acuity (BCVA) and spectral-domain optical coherence tomography (SD-OCT) to measure central macular thickness (CMT). PED size was measured at each visit in 3 dimensions: maximum width, height and length. Mean change was assessed between baseline and week 48 in each dimension. PEDs were categorised by location in relation to the fovea (sub/juxta and extrafoveal). Three types of PEDs were graded based on SD-OCT reflectivity signal under the retinal pigment epithelium (RPE): predominantly hyper-reflective signal below the RPE (solid), predominantly hypo-reflective signal below the RPE (hollow) and a combination of solid and hollow (mixed). Correlations between change in PED size and changes in BCVA and CMT were assessed.
At week 48, mean maximum PED height, width and length reduced significantly (-53.5µm, -276.8µm and -301.9µm, respectively) when compared to baseline (p<0.01 for all). Complete PED resolution occurred in 4 patients (9.3%) over the 12 month period. A reduction in all 3 individual PED dimensions were significantly correlated with a reduction in CMT (p<0.01) but not BCVA (p>0.05). Thirty four (79%) PED were subfoveal/juxta and 9 (21%) were extrafoveal. Patients with extrafoveal PED had a greater reduction in PED height compared to patients with subfoveal/juxta PED (p=0.05). Twenty-one (49%) PED were solid, 13 (30%) were hollow and 9 (21%) were mixed. Patients with hollow PED and mixed PED had a greater reduction in all 3 individual PED dimensions compared to solid PED (p<0.05 for all).
Intravitreal aflibercept was effective in reducing PED size in patients with nAMD and was correlated with a reduction in CMT. Aflibercept achieved complete PED resolution in 9.3% of patients, with a trend towards hollow, extrafoveal PED being the most responsive to therapy.
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