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Sabah Shah, Di Zhou, Jason S Slakter, Lawrence A Yannuzzi, Irene A Barbazetto, K Bailey Freund; Aflibercept for the Treatment of Polypoidal Choroidal Vasculopathy. Invest. Ophthalmol. Vis. Sci. 2014;55(13):4046.
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© ARVO (1962-2015); The Authors (2016-present)
Polypoidal Choroidal Vasculopathy (PCV) is a form of neovascularization seen with increased prevalence in the Asian population, but can be seen as a variant of age related macular degeneration (AMD). Previous treatment with photodynamic therapy (PDT) or anti-vascular endothelial growth factor (VEGF) treatment with intravitreal ranibizumb (IVR) or bevacizumab (IVB) have demonstrated varying degrees of success. This study describes the difference in outcome of treatment using Aflibercept for the treatment of PCV.
Forty-eight eyes of 37 patients with PCV treated with aflibercept. Multimodal imaging characteristics of PCV and visual acuity before and after treatment with PDT, ranbizumab, and bevacizumab, compared to the same measures after treatment with aflibercept intravitreal anti- VEGF therapy. Clinical and imaging characteristics were evaluated at baseline, after the initiation of PDT and anti-VEGF therapy, and following the use of aflibercept.
The mean ± standard deviation (SD) age at presentation of PCV was 71.7 years ± 8.01 years and follow-up was 53.5± 32.5 months. Visual acuity (Va) before and after IVR and/or IVB was 0.567 ± 0.420 (20/74) and 0.523 ± 0.427 (20/67) respectively (p=.302). The decrease in the largest polyp height was 15% on OCT with either PDT, IVR and/or IVB. The mean number of IVR and /or IVB injections received prior to aflibercept treatment was 23 ± 14 and 11 ± 10 injections respectively. 19.6% (9/46) of eyes had a complete resolution of the polyp after some combination of PDT, IVR and/or IVB. The mean VA before and after Aflibercept treatment was 0.523 ± 0.427 (20/67) and 0.463 ± 0.390 (20/58), respectively (p=0.027). A mean reduction of 30.9% in height and 14.0% in the width of the largest polyp after the third aflibercept injection (p < 0.05) was seen. 35.4% (17/48) of eyes had a complete resolution of the polyp after their last aflibercept injection.
Aflibercept appears more effective than PDT, Ranibizumab and/or Bevacizumab in improving visual acuity and reducing polyp size in eyes harboring PCV. Intravitreal aflibercept administered on a monthly dosing regimen was shown to statistically improve vision and decrease polyp size. Further larger and long-term prospective randomized studies are needed to determine the true efficacy and safety profiles of aflibercept for patients with PCV.
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