Abstract
Purpose :
To describe the outcomes of intravitreal aflibercept for treatment-naïve eyes with retinal angiomatous proliferation (RAP) using a fixed regimen during the first year of treatment
Methods :
A prospective non-randomized clinical study of 14 treatment naïve eyes with chorioretinal neovascularization based on RAP lesion treated in the first year with a fixed regime of three consecutive monthly aflibercept injections followed by aflibercept in two-month intervals. The statistical evaluation of results was done after the first year of treatment (Month 13). The following parameters were assessed during the 1-year follow-up period: best corrected visual acuity (BCVA, in logMAR units), central macular thickness (CMT), central macular volume (CMV) (SD-OCT Heidelberg Spectralis) and the extent of macular atrophy in the macular area by fundus autofluorescence.
Results :
A total of 14 patients were included in this study. Mean baseline BCVA in eyes with RAP lesion was 0,5 logMAR (range 0,006 - 0,9). After the first year of treatment BCVA was 0,28 logMAR (range -0,01 - 0,7). The mean change in BCVA was 11 ETDRS letters gain which was statistically significant (p<0,006). The average BCVA improved by 2 logMAR lines. The average baseline CMT was 425 microns (range 263 - 699) before treatment and significantly reduced to 308 microns (range 212 - 618) after treatment (p<0,006). The average baseline CMV was 9,75 mm3 (range 7,94 - 14,96 mm3) before treatment and significantly reduced to 8,33 mm3 (range 7,23 - 10,82) after treatment (p<0,013).
In 4 out of 14 eyes the development and progression of RPE atrophy was recorded, however, only in 2 eyes we were able to measure the area of atrophy. This small number of patients developing atrophy is consistent with the natural history of RAP lesions where atrophy seems to develop with or even without anti-VEGF therapy. We also observed the presence of intra/subretinal fibrosis in 6 eyes; due to its extrafoveal location this had no impact on final visual acuity
Conclusions :
Intravitreal aflibercept using a fixed regimen during the first year of treatment may be effective for improvement and stabilization of visual acuity in eyes with RAP. However, retinal pigment atrophy can develop during the first year of therapy as part of the natural history of the disease and can limit the final results of treatment
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.