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Laurence Shen Lim, Wei Yan Ng, Ian Yeo, Ranjana Mathur, Gemmy Cheung, Tien Yin Wong; Intravitreal Aflibercept Injections in the Management of Treatment Refractory Polypoidal Choroidal Vasculopathy. Invest. Ophthalmol. Vis. Sci. 2016;57(12):512.
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© ARVO (1962-2015); The Authors (2016-present)
To determine if eyes with polypoidal choroidal vasculopathy (PCV) unresponsive to intravitreal ranibizumab or bevacizumab injections would benefit from conversion to aflibercept.
This retrospective case series included 40 eyes of 37 patients with PCV unresponsive to ranibizumab and/or bevacizumab injections and who were subsequently converted to aflibercept. All patients had persistent exudation despite at least 3 consecutive monthly intra-vitreal bevacizumab or ranibizumab injections. Visual outcomes and spectral domain optical coherence tomography (OCT) changes were analysed.
The mean age of the subjects was 65.7 ± 8.7years, 21(57%) were male and all were of Asian ethnicity. The mean number of ranibizumab or bevacizumab injections before switching to aflibercept was 8.8, and the mean number of aflibercept injections after switching was 3.3. The mean follow-up was 7.0±3.1 months. Of the 40 eyes, 28 (70%) had complete resolution of exudation with aflibercept treatment. Mean central foveal thickness (CFT) was 244.90±120.72μm immediately prior to the switch, decreased to 190.20±104.99μm (p=0.004) after one aflibercept injection, and decreased further to 189.05±98.71μm at the end of follow-up.(p<0.001 compared to baseline) The mean macular cube volume also showed significant reduction from 9.72±2.17μm3 pre-conversion to 9.01±2.08μm3 after one aflibercept injection (p<0.001), and was 8.95±1.46μm3 at the last follow up (p=0.014 compared to baseline). Prior to conversion, 38 eyes (95%) had pigment epithelial detachments (PEDs). At the end of follow-up, PEDs in 3 eyes (7.9%) had resolved while 8 eyes (21.1%) had reductions in PED height. PEDs in the remaining 27 eyes (71.1%) were unchanged. Mean visual acuity was 0.72±0.69logMAR units just prior to the switch, 0.74±0.64 logMAR (p=0.06) after one aflibercept injection, and 0.72±0.63 logMAR at the end of follow-up.(p=0.12 compared to baseline)
Intra-vitreal aflibercept treatment appears to be effective in improving anatomical outcomes in patients with PCV refractory to bevacizumab or ranibizumab in the short term. Whether this results in long-term visual acuity gain is unclear.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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