Department of Ophthalmology, Kyung Hee University Medical Center, Kyung Hee University, Seoul, Republic of Korea.
Department of Ophthalmology, Seonam University Myongji Hospital, Goyang, Republic of Korea.
Retina. 2019 Feb;39(2):303-313. doi: 10.1097/IAE.0000000000001947.
To investigate the outcomes of intravitreal aflibercept in refractory pigment epithelial detachment (PED) with or without subretinal fluid (SRF) in patients with neovascular age-related macular degeneration.
A prospective, nonrandomized, interventional case series involved 40 patients with persistent vascularized PED previously treated with at least 3 injections of intravitreal bevacizumab or ranibizumab. Intravitreal aflibercept was administered as 3 initial loading doses every 4 weeks, followed by pro re nata retreatment every 8 weeks over 48 weeks. Pigment epithelial detachment was classified into solid-, hollow-, or mixed-type according to the reflective properties visualized using optical coherence tomography. The mean changes in best-corrected visual acuity, central subfield thickness, and the volumes of SRF and PED were analyzed.
The PED volume (baseline: 0.43 ± 0.55 mm) significantly reduced to 0.23 ± 0.32 mm at Week 8 (P = 0.003) and increased to 0.36 ± 0.41 mm at Week 48 (P = 0.345). The SRF volume (baseline: 0.52 ± 0.64 mm) significantly reduced to 0.24 ± 0.43 mm at Week 48 (P = 0.021). The mean baseline best-corrected visual acuity was 20/75 (47.5 letters); it showed no significant difference at Week 48 (+4.4 letters; P = 0.125). The baseline central subfield thickness was 323.2 ± 92.3 μm; it significantly reduced to 281.2 ± 90.7 μm at Week 48 (P = 0.001). In solid-type PEDs, there were poorer improvements in central subfield thickness, best-corrected visual acuity, and the volumes of the SRF and PED, with newly developed intraretinal cysts.
Intravitreal aflibercept in treatment-resistant neovascular age-related macular degeneration led to significant reduction in PED and SRF volume, central subfield thickness, and best-corrected visual acuity preserved, over 12 months. However, solid-type PED showed less improvement than hollow- or mixed-type PED.
研究玻璃体内注射阿柏西普治疗新生血管性年龄相关性黄斑变性伴或不伴脉络膜视网膜下积液（SRF）的难治性色素上皮脱离（PED）的结果。
前瞻性、非随机、干预性病例系列研究纳入了 40 例先前接受过至少 3 次玻璃体内贝伐单抗或雷珠单抗治疗的持续性血管化 PED 患者。玻璃体内注射阿柏西普，每 4 周给予 3 次初始负荷剂量，然后在 48 周内每 8 周按需进行重复治疗。根据光学相干断层扫描（OCT）显示的反射特性，将色素上皮脱离分为实性、空洞性或混合性。分析最佳矫正视力、中央视网膜下厚度（中央凹下厚度）以及 SRF 和 PED 体积的平均变化。
PED 体积（基线：0.43±0.55mm）在第 8 周时显著降低至 0.23±0.32mm（P=0.003），在第 48 周时增加至 0.36±0.41mm（P=0.345）。SRF 体积（基线：0.52±0.64mm）在第 48 周时显著降低至 0.24±0.43mm（P=0.021）。平均基线最佳矫正视力为 20/75（47.5 个字母）；第 48 周时无显著差异（增加 4.4 个字母；P=0.125）。基线中央凹下厚度为 323.2±92.3μm；第 48 周时显著降低至 281.2±90.7μm（P=0.001）。在实性 PED 中，中央凹下厚度、最佳矫正视力、SRF 和 PED 体积的改善较差，同时出现新的视网膜内囊。
玻璃体内注射阿柏西普治疗新生血管性年龄相关性黄斑变性导致 PED 和 SRF 体积、中央凹下厚度和最佳矫正视力在 12 个月内显著减少。然而，实性 PED 的改善不如空洞性或混合性 PED。
