Long-term Treatment Outcome of Intravitreal Aflibercept Monotherapy for Polypoidal Choroidal Vasculopathy

Ye Ji Kim; Sang Yun Han; Jong Woo Kim; Chul Gu Kim; Dong Won Lee; Jae Hui Kim

doi:10.3341/jkos.2018.59.3.238

Journal List > J Korean Ophthalmol Soc > v.59(3) > 1010868

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Kim, Han, Kim, Kim, Lee, and Kim: Long-term Treatment Outcome of Intravitreal Aflibercept Monotherapy for Polypoidal Choroidal Vasculopathy

Original Article

J Korean Ophthalmol Soc 2018;59(3):238-245.

Published online: 7 September 2018

DOI: https://doi.org/10.3341/jkos.2018.59.3.238

Long-term Treatment Outcome of Intravitreal Aflibercept Monotherapy for Polypoidal Choroidal Vasculopathy

Ye Ji Kim, MD, Sang Yun Han, MD, Jong Woo Kim, MD, Chul Gu Kim, MD, Dong Won Lee, MD, Jae Hui Kim, MD

Department of Ophthalmology, Kim 's Eye Hospital, Konyang University College of Medicine, Seoul, Korea

Address reprint requests to Jae Hui Kim, MD Department of Ophthalmology, Kim's Eye Hospital, #136 Yeongsin-ro, Yeongdeungpo-gu, Seoul 07301, Korea Tel: 82-2-2671-7665, Fax: 82-2-2671-6359, E-mail: kjh7997@daum.net

Received 14 December 2017 Revised 3 January 2018 Accepted 19 February 2018

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 long-term treatment outcomes of intravitreal aflibercept monotherapy for polypoidal choroidal vasculopathy (PCV).

Methods

A retrospective review of medical records was performed with 46 patients who were diagnosed with PCV and treated with aflibercept monotherapy for 24 months. Best-corrected visual acuity (BCVA) values measured at diagnosis, 3 months, 12 months, and 24 months were compared. Baseline morphological factors associated with the 24 month BCVA were additionally investigated.

Results

The mean age of the patients was 65.8 ± 7.9 years. The patients were treated with a mean of 7.0 ± 2.3 aflibercept injections. The mean logarithm of the minimal angle of resolution (logMAR) BCVA at diagnosis, 3 months, 12 months, and 24 months was 0.56 ± 0.40, 0.36 ± 0.36, 0.45 ± 0.42, and 0.52 ± 0.47, respectively. When compared with baseline values, the BCVA was significantly improved at 3 months (p < 0.001) and 12 months (p = 0.022). However, the value at 24 months was not significantly different (p = 1.000). The BCVA was improved or maintained in 35 eyes (76.1%). Extrafoveal polypoidal lesions were associated with a better 24 month visual outcome than subfoveal/juxtafoveal lesions.

Conclusions

Aflibercept monotherapy was found to be an effective method to maintain or improve long-term visual acuity in PCV patients. The location of polypoidal lesions was a predictive factor for long-term visual outcomes.

Keywords: Aflibercept, Age-related macular degeneration, Choroidal neovascularization, Long-term, Polypoidal choroidal vasculopathy

REFERENCES

1). Wong TY, Chakravarthy U, Klein R, et al. The natural history and prognosis of neovascular age-related macular degeneration: a systematic review of the literature and meta-analysis. Ophthalmology. 2008; 115:116–26.

2). Rosenfeld PJ, Brown DM, Heier JS, et al. Ranibizumab for neovascular age-related macular degeneration. N Engl J Med. 2006; 355:1419–31.

3). Brown DM, Kaiser PK, Michels M, et al. Ranibizumab versus verteporfin for neovascular age-related macular degeneration. N Engl J Med. 2006; 355:1432–44.

4). Rofagha S, Bhisitkul RB, Boyer DS, et al. Seven-year outcomes in ranibizumab-treated patients in ANCHOR, MARINA, and HORIZON: a multi-center cohort study (SEVEN-UP). Ophthalmology. 2013; 120:2292–9.

5). Heier JS, Brown DM, Chong V, et al. Intravitreal aflibercept (VEGF trap-eye) in wet age-related macular degeneration. Ophthalmology. 2012; 119:2537–48.

6). Cho H, Shah CP, Weber M, Heier JS. Aflibercept for exudative AMD with persistent fluid on ranibizumab and/or bevacizumab. Br J Ophthalmol. 2013; 97:1032–5.

7). Kim JH, Cho NC, Kim WJ. Intravitreal aflibercept for neovascular age-related macular degeneration resistant to bevacizumab and ranibizumab. J Korean Ophthalmol Soc. 2015; 56:1359–64.

8). Cho HJ, Kim KM, Kim HS, et al. Intravitreal aflibercept and ranibizumab injections for polypoidal choroidal vasculopathy. Am J Ophthalmol. 2016; 165:1–6.

9). Park KH, Song SJ, Lee WK, et al. The results of nation-wide registry of age-related macular degeneration in Korea. J Korean Ophthalmol Soc. 2010; 51:516–23.

10). Lee D, Jeong S, Moon J, et al. Analysis of efficacy of intravitreal aflibercept according to subfoveal choroidal thickness in polypoidal choroidal vasculopathy. J Korean Ophthalmol Soc. 2016; 57:1577–85.

11). Yang H, Jeon HM, Kim SW, et al. Short-term efficacy of intravitreal aflibercept for polypoidal choroidal vasculopathy. J Korean Ophthalmol Soc. 2015; 56:1728–35.

12). Kim IG, Kim YI, Kim JS, et al. Comparison of choroidal thickness change between ranibizumab and aflibercept in age-related macular degeneration: six month results. J Korean Ophthalmol Soc. 2017; 58:296–304.

13). Kawamura A, Yuzawa M, Mori R, et al. Indocyanine green angiographic and optical coherence tomographic findings support classification of polypoidal choroidal vasculopathy into two types. Acta Ophthalmol. 2013; 91:e474–81.

14). Yuzawa M, Mori R, Kawamura A. The origins of polypoidal choroidal vasculopathy. Br J Ophthalmol. 2005; 89:602–7.

15). Coscas G, Yamashiro K, Coscas F, et al. Comparison of exudative age-related macular degeneration subtypes in Japanese and French patients: multi-center diagnosis with multimodal imaging. Am J Ophthalmol. 2014; 158:309–18.e2.

16). Chung SE, Kang SW, Lee JH, Kim YT. Choroidal thickness in polypoidal choroidal vasculopathy and exudative age-related macular degeneration. Ophthalmology. 2011; 118:840–5.

17). Kim JH, Chang YS, Lee TG, Kim CG. Choroidal vascular hyperpermeability and punctate hyperfluorescent spot in choroidal neovascularization. Invest Ophthalmol Vis Sci. 2015; 56:1909–15.

18). Ma L, Li Z, Liu K, et al. Association of genetic variants with polypoidal choroidal vasculopathy: a systematic review and updated meta-analysis. Ophthalmology. 2015; 122:1854–65.

19). Oishi A, Kojima H, Mandai M, et al. Comparison of the effect of ranibizumab and verteporfin for polypoidal choroidal vasculopathy: 12-month LAPTOP study results. Am J Ophthalmol. 2013; 156:644–51.

20). Lee MH, An JH, Lee JE, Oum BS. Short-term efficacy of intravitreal bavacizumab for polypoidal choroidal vasculopathy. J Korean Ophthalmol Soc. 2009; 50:51–60.

21). Koh AH; Expert PCV Panel, Chen LJ, et al. Polypoidal choroidal vasculopathy: evidence-based guidelines for clinical diagnosis and treatment. Retina. 2013; 33:686–716.

22). Kim JH, Lee TG, Chang YS, et al. Short-term choroidal thickness changes in patients treated with either ranibizumab or aflibercept: a comparative study. Br J Ophthalmol. 2016; 100:1634–9.

23). Maruyama-Inoue M, Sato S, Yamane S, Kadonosono K. Intravitreal injection of aflibercept in patients with polypoidal choroidal vasculopathy: a 3-year follow-up. Retina. 2017; Aug. 14. DOI: 10.1097/IAE.0000000000001818. [Epub ahead of print].

24). Morimoto M, Matsumoto H, Mimura K, Akiyama H. Two-year results of a treat-and-extend regimen with aflibercept for polypoidal choroidal vasculopathy. Graefes Arch Clin Exp Ophthalmol. 2017; 255:1891–7.

25). Fung AE, Lalwani GA, Rosenfeld PJ, et al. An optical coherence tomography-guided, variable dosing regimen with intravitreal ranibizumab (Lucentis) for neovascular age-related macular degeneration. Am J Ophthalmol. 2007; 143:566–83.

26). Freund KB, Korobelnik JF, Devenyi R, et al. Treat-and-extend regimens with anti-VEGF agents in retinal diseases: a literature review and consensus recommendations. Retina. 2015; 35:1489–506.

27). Hikichi T, Kitamei H, Shioya S. Prognostic factors of 2-year outcomes of ranibizumab therapy for polypoidal choroidal vasculopathy. Br J Ophthalmol. 2015; 99:817–22.

28). Chang YS, Kim JH, Kim JW, et al. Polypoidal choroidal vasculopathy in patients aged less than 50 years: characteristics and 6-month treatment outcome. Graefes Arch Clin Exp Ophthalmol. 2016; 254:1083–9.

29). Kang HM, Koh HJ. Long-term visual outcome and prognostic factors after intravitreal ranibizumab injections for polypoidal choroidal vasculopathy. Am J Ophthalmol. 2013; 156:652–60.

30). Cho JH, Ryoo NK, Cho KH, et al. Incidence rate of massive submacular hemorrhage and its risk factors in polypoidal choroidal vasculopathy. Am J Ophthalmol. 2016; 169:79–88.

31). Pak KY, Park SW, Byon IS, Lee JE. Treat-and-extend regimen using rainbizumab for polypoidal choroidal vasculopathy: one-year results. Retina. 2017; 37:561–7.

Figure 1.

A representative case of polypoidal choroidal vasculopathy treated with intravitreal aflibercept monotherapy. At diagnosis (A-C), the decimal best-corrected visual acuity (BCVA) was 0.4. Subretinal fluid was resolved after 3 monthly aflibercept injections (D). The patient was treated with 9 aflibercept injections during the 24 months follow-up period. At 24 months (E), The BCVA was measured as 0.5. (A) Fluorescein angiography. (B) Indocyanine green angiography. (C-E) Optical coherence tomography images.

Figure 2.

Graphs showing functional and anatomical outcomes. Changes in the logarithm of the minimum angle of resolution (logMAR) best-corrected visual acuity (BCVA) (A) and central foveal thickness (B) in the included patients (n = 46). M = months.

Figure 3.

Proportion of patients when stratified into best-corrected visual acuity (decimal) (n = 46). At 24 months, 76.1% show visual acuity better than 0.1. M = months.

Table 1.

Characteristics of the included patients (n = 46)

Characteristics	Value
Age (years)	65.8 ± 7.9
Sex (men:women)	33:13
Baseline best-corrected visual acuity (logMAR)	0.56 ± 0.40
Baseline central foveal thickness (μm)	461.3 ± 206.1
Type of PCV (n, %)
Type 1	15 (32.6)
Type 2	31 (67.4)
Location of the polyps (n, %)
Subfoveal/Juxtafoveal	28 (60.9)
Extrafoveal	18 (39.1)
Largest polyp diameter (μm)	231.4 ± 132.6
Greatest linear dimension (μm)	2406.8 ± 913.8
Fovea-involving PED (n, %)	22 (47.8)

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

logMAR = logarithm of the minimal angle of resolution; PCV = polypoidal choroidal vasculopathy; PED = pigment epithelial detachment.

Table 2.

Comparison of baseline morphologic features between patients, when divided into 2 groups, according to best-corrected visual acuity (decimal) at 24 months (n = 46)

Characteristics	BCVA worse than 0.5 (n = 23)	BCVA 0.5 or better (n = 23)	p-value
Baseline central foveal thickness (n, %)			1.000*
< 400 μm	11 (47.8)	11 (47.8)
≥ 400 μm	12 (52.2)	12 (52.2)
Type of PCV (n, %)			0.345*
Type 1	9 (39.1)	6 (26.1)
Type 2	14 (60.9)	17 (73.9)
Location of the polypoidal lesion (n, %)			0.016*
Subfoveal/Juxtafoveal	18 (78.3)	10 (43.5)
Extrafoveal	5 (21.7)	13 (56.5)
Largest polyp diameter (n, %)			0.555*
< 200 μm	11 (47.8)	13 (56.5)
≥ 200 μm	12 (52.2)	10 (43.5)
Greatest linear dimension (n, %)			0.767*
<2,500 μm	12 (52.2)	13 (56.5)
≥ 2,500 μm	11 (47.8)	10 (43.5)
Fovea-involving PED (n, %)			0.555*
Presence	12 (52.2)	10 (43.5)
Absence	11 (47.8)	13 (56.5)

Values are presented as n (%) unless otherwise indicated.

BCVA = best-corrected visual acuity; PCV = polypoidal choroidal vasculopathy; PED = pigment epithelial detachment.

^* Statistical analysis with the chi-square test.

Table 3.

Association between baseline morphologic features and best-corrected visual acuity at 24 months (n = 46)

Morphologic features	p-value*
Baseline central foveal thickness	0.772
Type of PCV	0.331
Location of the polypoidal lesion	0.020
Largest polyp diameter	0.516
Greatest linear dimension	0.994
Fovea-involving PED	0.796

PCV = polypoidal choroidal vasculopathy; PED = pigment epithelial detachment.

^* Statistical analysis with binary logistic regression.

TOOLS

Similar articles