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

J Korean Ophthalmol Soc 2016;57(10):1577-1585.

Published online: 25 September 2016

DOI: https://doi.org/10.3341/jkos.2016.57.10.1577

Analysis of Efficacy of Intravitreal Aflibercept According to Subfoveal Choroidal Thickness in Polypoidal Choroidal Vasculopathy

Donghun Lee, MD, Seongyong Jeong, MD, Jongwon Moon, MD, Junyeop Lee, MD, PhD, Min Sagong, MD, PhD

Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea

Address reprint requests to Min Sagong, MD, PhD Department of Ophthalmology, Yeungnam University Hospital, #170 Hyeonchung-ro, Nam-gu, Daegu 42415, Korea Tel: 82-53-620-3443, Fax: 82-53-626-5936 E-mail: msagong@ynu.ac.kr

Received 9 June 2016       Accepted 13 June 2016

Copyright © 2016 Korean Ophthalmological Society

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 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.

Keywords: Aflibercept, Choroidal thickness, Polypoidal choroidal vasculopathy

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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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