Short-Term Efficacy of Intravitreal Aflibercept for Polypoidal Choroidal Vasculopathy

Heon Yang; Hye Min Jeon; Sang Won Kim; Hee Seong Yoon; Woo Seok Choae

doi:10.3341/jkos.2015.56.11.1728

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Yang, Jeon, Kim, Yoon, and Choae: Short-Term Efficacy of Intravitreal Aflibercept for Polypoidal Choroidal Vasculopathy

Original Article

J Korean Ophthalmol Soc 2015;56(11):1728-1735.

Published online: 29 August 2015

DOI: https://doi.org/10.3341/jkos.2015.56.11.1728

Short-Term Efficacy of Intravitreal Aflibercept for Polypoidal Choroidal Vasculopathy

Heon Yang, M.D, Hye Min Jeon, M.D, Sang Won Kim, M.D, Hee Seong Yoon, M.D, Woo Seok Choae, M.D

Sungmo Eye Hospital, Busan, Korea

Address reprint requests to Woo Seok Choae, MD Sungmo Eye Hospital, #409-1 Haeun-daero, U-dong, Haeundae-gu, Busan 48064, Korea Tel: 82-51-743-0775, Fax: 82-51-743-0776 E-mail: choiooseok@hanmail.net

‗ This study was presented as an e-poster at the 112th Annual Meeting of the Korean Ophthalmological Society 2014.

Received 16 January 201530 June 2015 Accepted 21 August 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the short-term effect of intravitreal aflibercept (Eylea^®; Regeneron Pharmaceuticals Inc., Tarrytown, NY, USA and Bayer, Basel, Switzerland) on the visual outcomes and retinal anatomic changes of patients with polypoidal choroidal vasculopathy (PCV).

Methods

Intravitreal Eylea^® was injected into 16 eyes of 16 patients with PCV in this retrospective case study. After therapy, the patients were followed up for over 3 months. Changes in best-corrected visual acuity (BCVA) and central foveal thickness (CFT) using optical coherence tomography (OCT) and abnormal vasculature on indocyanine green angiography (ICGA) were evaluated.

Results

The mean log MAR BCVA was 0.75 ± 0.60 at baseline, 0.74 ± 0.60 and 0.71 ± 0.63 at 1 and 2 months, respectively ( p > 0.05) and 0.57 ± 0.53 at 3 months (p < 0.05) after treatment. The mean CFT was 379 ± 130 μm at baseline, 281 ± 92 μm, 247 ± 54 μ m, and 231 ± 51 μ m at 1, 2, and 3 months, respectively, after treatment ( p < 0.05). Complete resolution was 43%, 55%, and 50% at 1, 2, and 3 months, respectively in pigment epithelial detachment (PED), 67%, 83%, and 92% at 1, 2, and 3 months, re-spectively in subretinal fluid (SRF) and 33%, 60%, and 60% at 1, 2, and 3 months, respectively in intraretinal fluid (IRF) using OCT. The polypoidal lesions in ICGA decreased in 12 of 14 eyes (86%).

Conclusions

Intravitreal injection of Eylea^® with PCV reduced CFT due to decreased retinal PED, SRF, IRF and occluded effec-tively the polypoidal lesion leaking. Compared with baseline, mean BCVA at the 3-month follow-up was significantly improved.

Keywords: Aflibercept, Intravitreal injection, Polypoidal choroidal vasculopathy

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Figure 1.

Change in logarithm of the minimum angle of reso-lution (log MAR), best-corrected visual acuity with time (months). Decrease at 1, 2, and 3 months was observed. A sig-nificant decrease was found at 3 months ( p < 0.05). Case 8, 11 were loss to FU after 1 month. FU = follow-up.

Figure 2.

Change in percentage (%), in proportion of more than 0.2 log MAR with time (months). Increase in proportion of gain more than 0.2 log MAR, decrease in proportion of loss more than 0.2 log MAR with time was observed. log MAR = logarithm of the minimum angle of resolution.

Figure 3.

Change in CFT (μ m) with time (months). A sig-nificant decrease was found at 1, 2, and 3months ( p < 0.05). Case 8, 11 were loss to FU after 1 month. CFT = central fo-veal thickness; FU = follow-up.

Figure 4.

Case No. 5 (A) Baseline fundus photograph shows hard exudates, pigmentations around macula. (B) Baseline horizontal OCT image and (C) vertical OCT image shows protruding polyps and macular edema. (D-F) One month after the third injection, PED, SRF was completely resolved. OCT = optical coherence tomography; PED = pigment epithelial detachment; SRF= sub-retinal fluid.

Figure 5.

Case No. 5 (A) Baseline ICGA shows polypoidal dilatation of choroidal vessels and branching vascular network. (B) One month after the third injection, polyps are resolved. But branching vascular network remains. ICGA = indocyanine green angiography.

Table 1.

Patient characterstics and clinical data before and after intravitreal injection of aflibercept for PCV

Case No.	Age (years)	Sex	Pre Tx BCVA (log MAR)	Post Tx BCVA (log MAR)	Pre Tx CFT (μ m)	Post Tx CFT (μ m)	BVN leak reduction	Polyp closure	No. of injection
1	73	M	2.12	1.7	444	154	P	-	3
2	73	M	0.64	0.52	345	219	P	C	3
3	72	F	0.52	0.52	687	223	C	C	3
4	70	M	0.3	0.22	358	233	-	C	3
5	72	M	0.4	0.35	444	201	C	C	3
6	61	M	0.7	0.52	274	187	C	P	3
7	69	M	0.1	0.35	249	208	C	C	3
8	78	M	0.52	FU loss	389	FU loss	FU loss	FU loss	2
9	80	M	1.4	1.4	629	233	P	C	3
10	53	F	0.1	0.05	227	178	P	P	3
11	75	M	1.7	FU loss	322	FU loss	FU loss	FU loss	2
12	76	M	1.22	1.1	255	257	P	P	3
13	56	M	0.22	0.1	333	261	P	-	3
14	70	M	0.4	0.1	271	232	P	C	3
15	73	M	1.22	1	431	344	P	C	3
16	65	M	0.47	0.1	406	312	P	C	3

PCV = polypoidal choroidal vasculopathy; Tx = treatment; BCVA = best corrected visual acuity; CFT = central foveal thickness; BVN branching vascular network; FU = follow-up; P = partial; C = complete.

Table 2.

Change in percentage (%), in proportion of partial or complete solution in PED, SRF, IRF by OCT

	N	Partial solution at 1 month (n, %)	Complete solution at 1 month (n, %)	Partial solution at 2 months (n, %)	Complete solution at 2 months (n, %)	Partial solution at 3 months (n, %)	Complete solution at 3 months (n, %)
PED	14	4/14 (29)	6/14 (43)	4/11 (36)	6/11 (55)	6/12 (50)	6/12 (50)
SRF	15	5/15 (33)	10/15 (67)	2/12 (17)	10/12 (83)	1/13 (8)	12/13 (92)
IRF	6	3/6 (50)	2/6 (33)	2/5 (40)	3/5 (60)	2/5 (40)	3/5 (60)

All cases were significantly improved partially or completely within 3 months.

PED = pigment epithelial detachments; SRF = subretinal fluid; IRF = intraretinal fluid; OCT = optical coherence tomography.

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