April 2014
Volume 55, Issue 13
Free
ARVO Annual Meeting Abstract  |   April 2014
Response of Pigment Epithelial Detachments following Intravitreal Aflibercept for Age-Related Macular Degeneration
Author Affiliations & Notes
  • Thomas Hong
    Sydney Institute of Vision Science, Sydney, NSW, Australia
    Sydney Retina Clinic and Day Surgery, Sydney, NSW, Australia
  • Geoffrey Broadhead
    Sydney Institute of Vision Science, Sydney, NSW, Australia
    Sydney Retina Clinic and Day Surgery, Sydney, NSW, Australia
  • Meidong Zhu
    Sydney Institute of Vision Science, Sydney, NSW, Australia
    Sydney Retina Clinic and Day Surgery, Sydney, NSW, Australia
  • Haitao Li
    Sydney Institute of Vision Science, Sydney, NSW, Australia
    Sydney Retina Clinic and Day Surgery, Sydney, NSW, Australia
  • Timothy Schlub
    Sydney Institute of Vision Science, Sydney, NSW, Australia
  • Wijeyanthy Wijeyakumar
    Sydney Institute of Vision Science, Sydney, NSW, Australia
    Sydney Retina Clinic and Day Surgery, Sydney, NSW, Australia
  • Andrew Alexander Chang
    Sydney Institute of Vision Science, Sydney, NSW, Australia
    Sydney Retina Clinic and Day Surgery, Sydney, NSW, Australia
  • Footnotes
    Commercial Relationships Thomas Hong, None; Geoffrey Broadhead, None; Meidong Zhu, None; Haitao Li, None; Timothy Schlub, None; Wijeyanthy Wijeyakumar, None; Andrew Chang, Alcon (C), Bayer (C), Bayer (F), Bayer (R), Novartis (C), Novartis (R)
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science April 2014, Vol.55, 3937. doi:https://doi.org/
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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. doi: https://doi.org/.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose: 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.

Methods: 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.

Results: 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).

Conclusions: 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.

Keywords: 412 age-related macular degeneration • 466 clinical (human) or epidemiologic studies: treatment/prevention assessment/controlled clinical trials • 688 retina  
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