Abstract
Purpose :
Complete disappearance of polypoidal lesions on ICG angiography following intravitreous aflibercept has been reported; however, the exact timing of this disappearance is not well characterized. Therefore, this study explored the timing of complete absence of polypoidal lesions on ICGA following aflibercept monotherapy in PCV.
Methods :
Eyes with newly-diagnosed PCV, by EVEREST criteria, enrolled between April 2016 and December 2017, were included. Eligible eyes received 3 monthly aflibercept injections, then bimonthly injections until one year (or as often as monthly if subretinal or intraretinal thickening was seen on OCT). PDT with verteporfin was added if persistent thickening and worsening visual acuity despite 6 monthly aflibercept injections. ICGA performed at baseline and q8 weeks thereafter and monthly OCT images were graded by two ophthalmologists to determine polypoidal status as complete absence (regression), incomplete absence (partial regression in size or number of polypoidal lesions), or no absence (no regression). If disagreement, both graders came to consensus with open adjudication.
Results :
A total of 40 PCV eyes (38 participants; 100% Thai, 61% female, mean [SD] age 64 [±8.3] years), presented with serous (15%), serosanguinous or exudative (66%), and massive hemorrhagic (18%) maculopathies. Baseline # of polypoidal lesions on ICGA were: 90% had ≥5 polypoidal lesions, 10% had 2-4 lesions. Ninety-five percent (38 of 40 eyes) received aflibercept monotherapy, and 5% (2 of 40 eyes) received aflibercept and subsequent PDT. Mean (SD) injection numbers were 8.5 [±1.1]. At 1 year, 55% (95%CI: 40%-70%) had complete absence, 20% (95%CI: 8%-32%) had partial absence, and 5% (95%CI: 0%-12%) had no regression. Of 22 eyes with complete absence, median (interquartile range) duration of complete absence was 3 months (2 to 6 months). Rate of complete absence (complete regression) at 2, 4, 6, 8, 10, 12 months was 50%, 9%, 18%, 5%, 9%, and 9%.
Conclusions :
Following aflibercept treatments, most eyes with PCV had complete absence (complete regression) of polypoidal lesions on ICGA before 6 months, few had no absence at 1 year. These findings support consideration of aflibercept for PCV initially without PDT when the goal is both improving visual acuity and getting absence or regression of polypoidal lesions.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.