References

Czech and Slovak Ophthalmology

157

10.31348/2020/16

Original article

Aflibercept for Vascularised Serous Pigment Epithelial Detachment: One-Year Anatomical and Functional Results

Románek

Jaroslav

Palyzová

Hana

Grygar

Jan

Ernest

Jan

https://orcid.org/0009-0003-2775-7070

1 10 2020

Purpose: To assess the effect of intravitreal aflibercept on pigment epithelial detachment (PED) secondary to occult choroidal neovascularization (CNV) in treatment-naive patients. Patients and methods: Retrospective analysis of thirty-six patients (thirty-eight eyes) with mean age 77 (SD ± 7), who were treated with aflibercept 2.0 mg (Eylea, Bayer) at the Department of Ophthalmology of 1st Faculty of Medicine of the Charles University and the Military University Hospital Prague. All patients were treated in fixed regimen, which means 3 loading doases 1 month apart, followed by further 2-monthly doses over total 12-month period. Best corrected visual acuity (BCVA) was evaluated on Early Treatment Diabetic Retinopathy Study (ETDRS) charts. Diameters as PED height, width and central retinal thickness (CRT) were assesed using spectral-domain optical coherence tomography. All previously mentioned were analyzed et the baseline and than at every visit. Therapy complications were also evaluated. Results: Borderline significant improvement in the mean of BCVA score of 3.2 letters (SD ± 11.6, p = 0.05) at the end of follow-up period was observed. Mean PED height at 12 months significantly decreased by 140 µm (SD ± 238, p < 0.01). Reductions in PED height were correlated with reductions in central macular thickness (R = 0.94, p < 0.001) simultaneously with PED width (R = 0.45, p < 0.01). There was no significant correlation between PED height decrease and visual acuity. PED rupture was observed in 3 eyes (8 %). Conclusion: Aflibercept intravitreal therapy in fixed regimen in patients with PED secondary to occult CNV shows great anatomical effect. However, correlation between PED diameters and visual acuity was not observed.

aflibercept anti-VEGF pigment epithelial detachment occult CNV

References

Klein, R., Klein, BE., Knudtson, MD., Meuer, SM., Swift, M., Gangnon, RE.: Fifteen-year cumulative incidence of age-related macular degeneration. Ophthalmology. 2007;114(2):253–262.

Bressler, NM.: Age-related macular degeneration is the leading cause of blindness. JAMA. 2004; 291(15):1900–1901.

Lommatzsch, APOD., Heimes, B., Gutfleisch, M. et al.: Serous pigment epithelial detachment in age-related macular degeneration: comparison of different treatments. Eye. 2009;23:2163–2168.

Poliner, LS., Olk, RJ., Burgess, D., Gordon, ME.: Natural history of retinal pigment epithelial detachments in age-related macular degeneration. Ophthalmology. 1986;93(5):543–551.

Suzuki, M., Nagai, N., Izumi-Nagai, K. et al.: Predictive factors for non-response to intravitreal ranibizumab treatment in agerelated macular degeneration. Br J Ophthalmol. 2014;98(9):1186–1191.

Ashraf, M., Souka, A., Adelman, RA.: Age‐related macular degeneration: using morphological predictors to modify cucisely the length of the “loading phase” that probably contributed to the better development of BCVA. In our study, average BCVA of 61 letters (SD ± 12) after 3 applications decreased to 59 letters (SD ± 14) after the 7th application. It is probable that this was contributed to by the change of monthly interval from the loading phase to the interval of dosing every two months. This conclusion is in accordance with other clinical trials engaging with the treatment of occult CNV associated with serous RPE detachment within a regimen of a two- -monthly application interval [15,16]. Broadhead et al. [15] analysed anatomical changes within the framework of one year of treatment with aflibercept in 43 eyes with RPE detachment secondary to CNV. This concerned a cohort of patients with a finding of resistant RPE detachment following prior anti-VEGF therapy. At the end of the observ

Patel, KH., Chow, CC., Rathod, R. et al.: Rapid response of retinal pigment epithelial detachments to intravitreal aflibercept in neovascular age-related macular degeneration refractory to bevacizumab and ranibizumab. Eye (Lond). 2013;27:663–667.

Parodi, MB., Iacono, P., Papayannis, A. et al.: Intravitreal ranibizumab for pigment epithelial detachment with subfoveal occult neovascularization: a prospective 24-month case series. Am J Ophthalmol. 2013;155:103–108.

Gonzalez, A., Khurshid, G.: Treatment of retinal pigment epithelial detachment secondary to exudative age-related macular degeneration. Am J Ophthalmol Case Rep. 2017;9:18–22.

Gass, JD.: Serous retinal pigment epithelial detachment with a notch. A sign of occult choroidal neovascularization. Retina 1984;4(4):205–220.

Bird, AC., Marshall, J.: Retinal pigment epithelial detachments in the elderly. Trans Ophthalmol Soc. 1986;105:674–682.

Pauleikhoff, D., Loffert, D., Spital, G. et al.: Pigment epithelial detachment in the elderly. Clinical differentiation, natural course and pathogenetic implications. Graefes Arch Clin Exp Ophthalmol. 2002;240(7):533–538.

Khanani, AM., Eichenbaum, D., Schlottmann, PG., Tuomi, L., Sarraf, D.: Optimal management of pigment epithelial detachments in eyes with neovascular age-related macular degeneration. Retina. 2018;38(11):2103–2117.

Chen, X., Al-Sheikh, M., Chan, CK. et al.: Type 1 versus type 3 neovascularization in pigment epithelial detachments associated with age-related macular degeneration after anti-vascular endothelial growth factor therapy: a prospective study. Retina. 2016;36(S1):S50–S64.

Broadhead, GK., Hong, T., Zhu, M. et al.: Response of pigment epithelial detachments to intravitreal aflibercept among patients with treatment-resistant neovascular age-related macular degeneration. Retina. 2015;35:975–981.

Zinkernagel, MS., Wolf, S., Ebneter, A.: Fluctuations in pigment epithelial detachment and retinal fluid using a bimonthly treatment regimen with aflibercept for neovascular age-related macular degeneration. Ophthalmologica. 2016;235:42–48.

Cho, HJ., Kim, KM., Kim, HS. et al.: Response of pigment epithelial detachment to anti-vascular endothelial growth factor treatment in age-related macular degeneration. Am J Ophthalmol. 2016;166:112–119.

Introini, U., Torres Gimeno, A., Scotti, F. et al.: Vascularized retinal pigment epithelial detachment in age-related macular degeneration: treatment and RPE tear incidence. Graefes Arch Clin Exp Ophthalmol. 2012;250:1283–1292.

Chan, CK., Abraham, P., Meyer, CH. et al.: Optical coherence tomography-measured pigment epithelial detachment height as a predictor for retinal pigment epithelial tears associated with intravitreal bevacizumab injections. Retina. 2010;30: 203–211.

Chang, LK., Sarraf, D.: Tears of the RPE: an old problem in a new era. Retina. 2007;27:523–527.

Cunningham, ET. Jr., Feiner, L., Chung, C. et al.: Incidence of retinal pigment epithelial tears after intravitreal ranibizumab injection for neovascular age-related macular degeneration. Ophthalmology. 2011;118:2447–2452.

Panos, GD., Gatzioufas, Z., Petropoulos, IK. et al.: Effect of ranibizumab on serous and vascular pigment epithelial detachments associated with exudative age-related macular degeneration. Drug Des Devel Ther. 2013;7:565–569.