Abstract
Purpose :
The long-term clinical efficacy and anatomical response to intravitreal aflibercept in the treatment of pigment epithelial detachment (PED) in neovascular age-related macular degeneration (nAMD) refractory to intravitreal ranibizumab remains unknown. Short-term outcomes have shown conflicting evidence of changes in visual acuity (VA), central subfield thickness (CST) and PED size. This 2-year retrospective, observational case review aimed to assess long-term outcomes using a treat and extend regimen.
Methods :
This study included 27 eyes of 27 patients aged 50+ years with nAMD-associated PED refractory to intravitral ranibizumab and switched to intravitreal aflibercept at Frimley Park Hospital between July 2013 and November 2015. Data collected included best-corrected LogMAR VA (BCVA), CST as well as height and horizontal expanse of the PED using case note review and optical coherence tomography imaging. Paired t-tests were used to compare these parameters at baseline to 12 months (12M) and 24 months (24M) post-switch.
Results :
Mean baseline BCVA and CST was 59.1±15.5 letters and 367.7±85.1μm respectively. Mean baseline PED height and horizontal expanse was 200.2±122.8μm and 2221.5±949.9μm respectively. Compared to baseline, mean BCVA improved by 3.81±4.18 letters (p=0.125) at 12M and 1.70±3.8 letters (p=0.54) at 24M. Mean CST increased by 50.8±106.3μm (p=0.65) at 12M but decreased by 72.5±21.1μm (p=0.002) at 24M compared to baseline. Concurrently, mean PED height decreased by 35.6±28μm (p=0.06) at 12M and 32.0±29.3μm (p=0.10) at 24M whereas mean PED horizontal expanse increased by 28.4±261.4μm (p=0.69) at 12M and 50.0±260.9μm (p=0.54) at 24M. There was no correlation between BCVA and PED height or horizontal expanse.
Conclusions :
Intravitreal aflibercept has previously been shown to improve BCVA and CST in treatment-resistant nAMD at 12M post-switch. This 2-year review shows non-significant improvement of BCVA compared to baseline but does demonstrate a statistically significant decrease in CST at 24M. There is a decrease in PED height at 24M but this effect is not statistically significant and the horizontal expanse of PED demonstrates an increasing trend. Larger case numbers are required to further assess the extent of effect of intravitreal aflibercept on nAMD-associated PED and its relationship to BCVA.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.