The effect of aflibercept in the treatment of exudative age-related macular degeneration combined with retinal pigment epithelial detachment_Chinese Journal of Ocular Fundus Diseases

Authors：

Deng Kaiyu ^1,2 , Huang Zhen ² , Huang Xiaoli ² , Ji Hong ³ , Han Yun ^1,2 ,  Song Yanping ^1,2

1. The First School of Clinical Medicine, Southern Medical University, Guangzhou 510000, China;
2. Department of Ophthalmology, Central Theater Command Hospital of People’s Liberation Army, Wuhan 430070, China;
3. Xiangyang Ai’er Ophthalmology Hospital Affiliated to Ai’er Eye Hospital Group Co.Ltd, Xiangyang 441000, China;

Corresponding?author：

Song Yanping, Email: songyanping@medmail.com.cn

Keywords：

Wet macular degeneration/drug therapy; Retinal pigment epithelium /therapy; Angiogenesis inhibitors/therapeutic use

DOI：

10.3760/cma.j.cn511434-20200608-00266

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Objective To observe the efficacy of intravitreal injection of aflibercept (IVA) in the treatment of exudative age-related macular degeneration (wAMD) combined with RPE detachment (PED).Methods A retrospective case study. From June 2018 to June 2019, 32 eyes (overall group) of 27 wAMD patients with PED were included in the study. All eyes were treated with IVA. The initial loading dose was 2.0 mg, which was injected once a month for 2 consecutive months and and then use a PRN regimen after evaluation. According to the maximum height of PED (PEDH) 2 months after treatment, the overall group was divided into the response group and the partial response group, with 20 (62.50%) and 12 (37.50%) eyes respectively. The response group: PEDH decreased by ≥25% compared with before treatment. The partial response: PEDH decreased by ＜25%. The macular fovea was scanned with the 3D-OCT 2000 instrument from Topcon (Japan). PEDH, PED area (PEDA), PED volume (PEDV), and macular foveal retinal thickness (CMT) were measured. There was no significant difference in BCVA, CMT, PEDH, PEDA, and PEDV of the eyes in the response group and the partial response group (t=－0.791, －0.488, －0.900, －1.130, －0.400; P=0.435, 0.630, 0.380, 0.270, 0.690). The changes of BCVA, PEDH, PEDA, PEDV, CMT in each group were observed before treatment and 1, 2, 4, and 6 months after treatment. The comparison of BCVA and PED-related indicators and CMT before and after treatment were performed by repeated measures analysis of variance.Results Compared with before treatment, the BCVA, CMT, PEDH, PEDA and PEDV of the eyes in the overall group, the response group, and the partial response group were obviously improved after treatment. Among them, there were statistically significant differences in all indicators of the overall group and the response group (F_BCVA=5.871, 3.798; P=0.001, 0.019. F_CMT=24.526, 14.109; P=0.000, 0.001. F_PEDH=12.569, 12.091; P=0.000, 0.000. F_PEDA=7.534, 6.286; P=0.000, 0.000. F_PEDV=5.139, 4.104; P=0.004, 0.014); there was no statistically significant difference in PED-related indicators in the partial response group (F_PEDH=3.210, P=0.054; F_PEDA=1.913, P=0.183; F_PEDV=3.500, P=0.051), the difference between BCVA and CMT was statistically significant (F_BCVA=3.033, P=0.027; F_CMT=11.140, P=0.001). Two months after treatment, the eye number of PEDH reduction rate ＜25%, 25%-＜50%, 50%-＜75%, and ≥75% were 12 (37.50%), 8 (25.00%), 9 (28.13%), and 3 (9.38%) in the overall group, respectively. And PED in one eye (3.13%) was completely eliminated. Six months after treatment, the proportion was 13 (40.23%), 5 (15.63%), 7 (21.88%) and 7 (21.88%), respectively, among which 4 eyes (12.50%) with PED were completely resolved.Conclusions Aflibercept treatment of wAMD combined with PED can restore its anatomical indicators and improve visual function of patients in a short time; the efficacy of PED in the PRN stage is related to the efficacy of the loading dose stage.

Citation： Deng Kaiyu, Huang Zhen, Huang Xiaoli, Ji Hong, Han Yun, Song Yanping. The effect of aflibercept in the treatment of exudative age-related macular degeneration combined with retinal pigment epithelial detachment. Chinese Journal of Ocular Fundus Diseases, 2020, 36(10): 764-771. doi: 10.3760/cma.j.cn511434-20200608-00266 Copy

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11.	楊誠, 于珊珊, 周煥嬌, 等. 抗血管內皮生長因子單克隆抗體bevacizumab治療滲出型老年性黃斑變性療效觀察及無效病例分析[J]. 中華眼底病雜志, 2011, 27(6): 529-533. DOI: 10.3760/cma.j.issn.1005-1015.2011.06.007.Yang C, Yu SS, Zhou HJ, et al. Therapeutic effects of intravitreal injection of bevacizumab on age-related macular degeneration and non-responders analysis[J]. Chin J Ocul Fundus Dis, 2011, 27(6): 529-533. DOI: 10.3760/cma.j.issn.1005-1015.2011.06.007.
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15.	Sato T, Ooto S, Suzuki M, et al. Retinal pigment epithelial tear after intravitreal aflibercept for neovascular age-related macular degeneration[J]. Ophthalmic Surg Lasers Imaging Retina, 2015, 46(1): 87-90. DOI: 10.3928/23258160-20150101-16.
16.	Cunningham EJ, Feiner L, Chung C, et al. Incidence of retinal pigment epithelial tears after intravitreal ranibizumab injection for neovascular age-related macular degeneration[J]. Ophthalmology, 2011, 118(12): 2447-2452. DOI: 10.1016/j.ophtha.2011.05.026.
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1. Chakravarthy U, Williams M. The royal college of ophthalmologists guidelines on AMD: executive summary[J]. Eye (Lond), 2013, 27(12): 1429-1431. DOI: 10.1038/eye.2013.233.
2. 鄒洪強, 田洪芹, 張艷平, 等. 阿柏西普治療眼底血管性疾病的臨床研究新進展[J]. 眼科新進展, 2017, 37(9): 894-897. DOI: 10.13389/j.cnki.rao.2017.0227.Zou HQ, Tian HQ, Zhang YP, et al. Recent advances in clinical research on aflibercept treating fundus vascular diseases[J]. Rec Adv Ophthalmol, 2017, 37(9): 894-897. DOI: 10.13389/j.cnki.rao.2017.0227.
3. Carrasco J, Pietsch GA, Nicolas MP, et al. Real-world effectiveness and real-world cost-effectiveness of intravitreal aflibercept and intravitreal ranibizumab in neovascular age-related macular degeneration: systematic review and meta-analysis of real-world studies[J]. Adv Ther, 2020, 37(1): 300-315. DOI: 10.1007/s12325-019-01147-6.
4. Au A, Parikh VS, Singh RP, et al. Comparison of anti-VEGF therapies on fibrovascular pigment epithelial detachments in age-related macular degeneration[J]. Br J Ophthalmol, 2017, 101(7): 970-975. DOI: 10.1136/bjophthalmol-2016-309434.
5. Waldstein SM, Simader C, Staurenghi G, et al. Morphology and visual acuity in aflibercept and ranibizumab therapy for neovascular age-related macular degeneration in the VIEW trials[J]. Ophthalmology, 2016, 123(7): 1521-1529. DOI: 10.1016/j.ophtha.2016.03.037.
6. Dirani A, Ambresin A, Marchionno L, et al. Factors influencing the treatment response of pigment epithelium detachment in age-related macular degeneration[J]. Am J Ophthalmol, 2015, 160(4): 732-738. DOI: 10.1016/j.ajo.2015.06.025.
7. de Massougnes S, Dirani A, Mantel I. Good visual outcome at 1 year in neovascular age-related macular degeneration with pigment epithelium detachment: factors influencing the treatment response[J]. Retina, 2018, 38(4): 717-724. DOI: 10.1097/IAE.0000000000001613.
8. Amoaku WM, Chakravarthy U, Gale R, et al. Defining response to anti-VEGF therapies in neovascular AMD[J]. Eye (Lond), 2015, 29(10): 1397-1398. DOI: 10.1038/eye.2015.159.
9. Diaconita V, Li B, Pal L, et al. Prospective evaluation of aflibercept in pigment epithelial detachments secondary to neovascular age related macular degeneration[J]. Can J Ophthalmol, 2019, 54(5): 626-634. DOI: 10.1016/j.jcjo.2019.01.004.
10. Simader C, Ritter M, Bolz M, et al. Morphologic parameters relevant for visual outcome during anti-angiogenic therapy of neovascular age-related macular degeneration[J]. Ophthalmology, 2014, 121(6): 1237-1245. DOI: 10.1016/j.ophtha.2013.12.029.
11. 楊誠, 于珊珊, 周煥嬌, 等. 抗血管內皮生長因子單克隆抗體bevacizumab治療滲出型老年性黃斑變性療效觀察及無效病例分析[J]. 中華眼底病雜志, 2011, 27(6): 529-533. DOI: 10.3760/cma.j.issn.1005-1015.2011.06.007.Yang C, Yu SS, Zhou HJ, et al. Therapeutic effects of intravitreal injection of bevacizumab on age-related macular degeneration and non-responders analysis[J]. Chin J Ocul Fundus Dis, 2011, 27(6): 529-533. DOI: 10.3760/cma.j.issn.1005-1015.2011.06.007.
12. Nguyen V, Daien V, Guymer R, et al. Projection of long-term visual acuity outcomes based on initial treatment response in neovascular age-related macular degeneration[J]. Ophthalmology, 2019, 126(1): 64-74. DOI: 10.1016/j.ophtha.2018.08.023.
13. 趙莼, 王方, 陳磊, 等. 玻璃體腔注射雷珠單抗治療滲出型老年性黃斑變性伴漿液性視網膜色素上皮脫離的療效觀察[J]. 中華眼底病雜志, 2015, 31(1): 27-30. DOI: 10.3760/cma.j.issn.1005-1015.2015.01.008.Zhao C, Wang F, Chen L, et al. Effect of ranibizumab on serous pigment epithelial detachments associated with wet age-related macular degeneration[J]. Chin J Ocul Fundus Dis, 2015, 31(1): 27-30. DOI: 10.3760/cma.j.issn.1005-1015.2015.01.008.
14. 馬楠, 陳有信. 息肉樣脈絡膜血管病變伴視網膜色素上皮撕裂的臨床特征[J]. 中華眼底病雜志, 2015, 31(4): 387-388. DOI: 10.3760/cma.j.issn.1005-1015.2015.04.020.Ma N, Chen YX. Clinical characteristics of polypoidal choroidal vasculopathy with retinal pigment epithelial tear[J]. Chin J Ocul Fundus Dis, 2015, 31(4): 387-388. DOI: 10.3760/cma.j.issn.1005-1015.2015.04.020.
15. Sato T, Ooto S, Suzuki M, et al. Retinal pigment epithelial tear after intravitreal aflibercept for neovascular age-related macular degeneration[J]. Ophthalmic Surg Lasers Imaging Retina, 2015, 46(1): 87-90. DOI: 10.3928/23258160-20150101-16.
16. Cunningham EJ, Feiner L, Chung C, et al. Incidence of retinal pigment epithelial tears after intravitreal ranibizumab injection for neovascular age-related macular degeneration[J]. Ophthalmology, 2011, 118(12): 2447-2452. DOI: 10.1016/j.ophtha.2011.05.026.
17. Fujii A, Imai H, Kanai M, et al. Effect of intravitreal aflibercept injection for age-related macular degeneration with a retinal pigment epithelial tear refractory to intravitreal ranibizumab injection[J]. Clin Ophthalmol, 2014, 8: 1199-1202. DOI: 10.2147/OPTH.S65810.

Chinese Journal of Ocular Fundus Diseases

The effect of aflibercept in the treatment of exudative age-related macular degeneration combined with retinal pigment epithelial detachment

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