Journal List > J Korean Ophthalmol Soc > v.57(10) > 1010424

Lee, Jeong, Moon, Lee, and Sagong: Analysis of Efficacy of Intravitreal Aflibercept According to Subfoveal Choroidal Thickness in Polypoidal Choroidal Vasculopathy

Abstract

Purpose

To evaluate the effect of intravitreal aflibercept according to subfoveal choroidal thickness in patients with polypoidal choroidal vasculopathy (PCV).

Methods

We retrospectively analyzed the medical records of 60 eyes from 60 patients with PCV treated with intravitreal aflibercept. The patients were followed for at least 6 months after the first injection. Using software, subfoveal choroidal thick-ness was manually measured as the distance from the hyperreflective line of Bruch's membrane to the chorioscleral interface on optical coherence tomography. The patients were divided into three groups based on subfoveal choroidal thickness. Visual acuity, subfoveal choroidal thickness, central macular thickness and largest pigment epithelial detachment (PED) height, polyp regression rate, and dry macula rate were evaluated to analyze the anatomical and functional outcomes.

Results

Baseline mean subfoveal choroidal thickness were 178.50 ± 28.42 μ m in the thin group (14 eyes, 23.3%), 287.03 ±43.58 μ m in the medium group (33 eyes, 55.0%), and 379.77 ± 17.09 μ m in the thick group (13 eyes, 21.7%). Baseline age, sex, visual acuity, central macular thickness, and the largest PED height did not differ significantly among the three subgroups. Only the thin group showed significant improvement of visual acuity at 6 months (p = 0.005). Subfoveal choroidal thickness, central macular thickness, and largest PED height were significantly decreased after treatment in all subgroups and did not differ among the subgroups. Compared with the other groups, the thin subfoveal choroidal thickness group showed higher polyp regression rate at 3 months and higher dry macula rate at 6 months (p = 0.013 and p = 0.004, respectively).

Conclusions

Intravitreal aflibercept injection was effective for the treatment of PCV, and thin subfoveal choroidal thickness was associated with better anatomical and functional outcomes.

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Figure 1.
Choroidal thickness was measured manually using a caliper that is provided in the optical coherence tomography device. The choroidal thickness (yellow arrow) was defined as the vertical distance between Bruch's membrane and the chorioscleral interface. (A) Thick choroidal thickness. (B) Thin choroidal thickness.
jkos-57-1577f1.tif
Figure 2.
Subtype comparison of changes in best corrected visual acuity (log MAR) after intravitreal aflibercept injection. Thin group patients had statistically significant improvement of best corrected visual acuity at 3 months and 6 months compared to the baseline (3 months p = 0.008, 6 months p = 0.005, paired t-test). There was no statistically significant improvement in medium group and thick group. VA = visual acuity.
jkos-57-1577f2.tif
Figure 3.
Subtype comparison of changes in subfoveal choroidal thickness (μ m) after intravitreal aflibercept injection. Choroidal thickness of all each group significantly decreased at 3 months and 6 months compared to the baseline. No stat-istical differences were shown among 3 groups for 6 months.
jkos-57-1577f3.tif
Figure 4.
Subtype comparison of complete polyp regression rate at 3 months after 1st intravitreal aflibercept injection. The thin subfoveal choroidal thickness group showed higher complete polyp regression rate at 3 months.
jkos-57-1577f4.tif
Figure 5.
Subtype comparison of anatomical outcomes using dry macula rate at 6 months after 1st intravitreal aflibercept injection. The thin subfoveal choroidal thickness group showed higher dry macula rate at 6 months.
jkos-57-1577f5.tif
Table 1.
Baseline characteristics
  Total Thin group Medium group Thick group p-value
Number of patients Mean F/U period (months) 60 10.8 ± 4.96 14 (23.3%) 9.50 ± 4.94 33 (55.0%) 10.4 ± 4.74 13 (21.7%) 13.2 ± 5.13 0.130
Age (years) 68.63 ± 7.42 71.21 ± 7.66 68.03 ± 7.37 67.38 ± 7.21 0.325
Gender (male:female) 51 (85%):9 (15%) 13:1 (92.9%:7.1%) 28:5 (84.8%:15.2%) 10:3 (76.9%:23.1%) 0.489*
Number of injections for 6 months          
   Average number of injection   3.71 ± 0.47 3.82 ± 0.39 3.92 ± 0.28 0.387
   Number of eyes 3 times injected   4 (28.6) 6 (18.2) 1 (7.7) 0.058
   Number of eyes 4 times injected   10 (71.4) 27 (81.8) 12 (92.3) 0.058
Refractive errors (SE, diopters) 0.56 ± 0.99 0.59 ± 0.81 0.46 ± 1.11 0.77 ± 0.86 0.620
Baseline VA (log MAR) 0.71 ± 0.43 0.52 ± 0.37 0.75 ± 0.46 0.80 ± 0.36 0.124
Baseline subfoveal choroidal thickness (μ m) 281.80 ± 77.00 178.50 ± 28.42 287.03 ± 43.58 379.77 ± 17.09 <0.001
Baseline central macular thickness (μ m) 456.87 ± 129.39 407.29 ± 100.45 464.03 ± 139.45 492.08 ± 123.18 0.136
Baseline largest PED height (μ m) 317.02 ± 174.86 292.29 ± 145.03 289.09 ± 186.36 414.54 ± 147.56 0.052

Values are presented as mean ± SD or n (%) unless otherwise indicated.

F/U = follow up; SE= spherical equivalent; VA = visual acuity; PED = pigment epithelial detachment.

* Fisher's exact test

One way analysis of variance (ANOVA)

Pearson Chi square test.

Table 2.
Changes of visual acuity, subfoveal thickness, central macular thickness and largest PED height of 60 eyes after intravitreal aflibercept injection
  Baseline 3 months 6 months
VA (log MAR) 0.71 ± 0.43 0.59 ± 0.44 0.56 ± 0.40
p-value   0.007* <0.001*
Subfoveal choroidal thickness (μ m) 281.80 ± 77.00 239.12 ± 77.66 240.20 ± 77.69
p-value   <0.001* <0.001*
Central macular thickness (μ m) 456.87 ± 129.39 288.33 ± 104.92 314.97 ± 97.50
p-value   0.001 0.001
Largest PED height (μ m) 317.02 ± 174.86 189.50 ± 134.56 187.90 ± 131.71
p-value   <0.001* <0.001*

Values are presented as mean ± SD unless otherwise indicated.

PED = pigment epithelial detachment; VA = visual acuity.

* Wilcoxon signed rank test

Paired t-test.

Table 3.
Comparison of baseline indocyanine green angiography findings among 3 subgroups
  Thin Medium Thick p-value
Location of polyps       0.499*
   Subfovea 4 (28.6) 11 (33.3) 3 (23.1)  
   Parafovea 9 (64.3) 15 (45.5) 5 (38.5)  
   Perifovea 1 (7.1) 6 (18.2) 3 (23.1)  
Outside from perifovea 0 (0) 1 (3.0) 2 (15.4)  
Number of polyps 3.79 ± 3.26 3.15 ± 2.65 3.69 ± 1.70 0.401
Size of polyps (μ m) 150.77 ± 54.62 172.61 ± 73.31 215.00 ± 70.90 0.305

Values are presented as mean ± SD or n (%) unless otherwise indicated.

* Fisher's exact test

Kruskal-Wallis test.

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