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Aditya Kanesa-thasan, Dilraj Singh Grewal, Manjot Gill, Rukhsana Mirza, Alice T Lyon; Quantification Of Change In Pigment Epithelial Detachment Morphology 18 Months Following Transition To Intravitreal Aflibercept In Eyes With Recalcitrant Neovascular Age Related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2014;55(13):3958.
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© ARVO (1962-2015); The Authors (2016-present)
To quantitatively evaluate the change in Pigment Epithelial Detachment (PED) volume, height and greatest basal diameter on SD-OCT, 18 months following the transition to 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 ranibizumab or bevacizumab injections in 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 (Heidelberg Engineering, Carlsbad, CA) were calculated using the software caliper measurement tool at baseline and following 18 months of aflibercept. PED volume was calculated by outlining the PED on individual OCT slices of the raster scan and multiplying it by the pixel dimensions and distance between slices. Eyes were excluded if the PED extended to the edge of the scan or did not fit within the scan area.
12 eyes of 12 patients (7 males, 5 females; mean age 80.5±4.3 years) who had received an average of 27.2±19.8 (range 6-70) prior ranibizumab or bevacizumab injections over 30.7±18.4 months were included. Mean baseline BCVA was 0.36±0.24 logMAR (range 0.1-0.9). Mean PED GBD was 2354.5±916.1 μm (range 457-4392 μm), mean MH was 294±175.9 μm (110-635 μm) and mean PED volume was 0.65±0.81mm3. Baseline central foveal thickness (CFT) was 339.6±109.5 μm and macular volume (MV) was 7.48±1.29 mm3. At 18 months follow-up, after receiving a mean of 14.3±3.5 (range 6-19) aflibercept injections, mean BCVA was 0.37±0.14 logMAR (range 0-0.83, p=0.9). Mean PED volume improved to 0.53±0.68mm3 (p=0.019), mean MH improved to 203.2±97.3 μm (range 85-456 μm, p=0.03) and PED GBD changed to 2531.4±1226 μm (range 459- 5074 μm, p=0.32). CFT reduced to 318.4±102.4 μm (p=0.07) and MV was 7.3±0.99 mm3 (p=0.38).
After 18 months of transitioning to aflibercept, recalcitrant PED volumes reduced by 19.4% and PED height reduced by 22.2% while preserving visual acuity. In eyes with recalcitrant neovascular AMD and a concurrent PED, aflibercept led to significant anatomic improvement in PED dimensions.
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