Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Apr 13:15:1539-1549.
doi: 10.2147/OPTH.S285257. eCollection 2021.

Effects of Intravitreous Aflibercept Injection in Pachychoroid Neovasculopathy: Comparison with Typical Neovascular Age-Related Macular Degeneration

Sufian Elfandi  1 , Sotaro Ooto  1 , Manabu Miyata  1 , Naoko Ueda-Arakawa  1 , Yousif Subhi  1   2 , Kenji Yamashiro  1 , Hiroshi Tamura  1 , Akio Oishi  1 , Masayuki Hata  1 , Nagahisa Yoshimura  1 , Akitaka Tsujikawa  1
Affiliations

Effects of Intravitreous Aflibercept Injection in Pachychoroid Neovasculopathy: Comparison with Typical Neovascular Age-Related Macular Degeneration

Sufian Elfandi et al. Clin Ophthalmol. .

Abstract

Purpose: To compare the 12-month efficacy of intravitreous aflibercept (IVA) injection between eyes with pachychoroid neovasculopathy and neovascular age-related macular degeneration (AMD).

Methods: Retrospective, comparative case series analysis. Twenty-seven eyes with pachychoroid neovasculopathy and sixty-three eyes with neovascular AMD. All patients received three initial monthly, followed by bimonthly, IVA injections.

Results: Twelve months after initial treatment, the mean best-corrected visual acuity (BCVA) had improved both in pachychoroid neovasculopathy (from 0.28 to 0.14 logMAR; P = 0.001) and neovascular AMD (from 0.40 to 0.29 logMAR; P < 0.001). Twelve months after initial treatment, eyes with pachychoroid neovasculopathy exhibited decreased mean central retinal thickness (CRT) and subfoveal choroidal thickness (both, P < 0.001) and presence of polyps (P = 0.039) and improved integrity of external limiting membrane (ELM) (P = 0.008) and ellipsoid zone band (P = 0.001). At the 12-month follow-up, 77% and 68% of eyes with pachychoroid neovasculopathy and neovascular AMD, respectively, exhibited dry macula (P = 0.30). Baseline CRT was correlated with 12-month BCVA in eyes with pachychoroid neovasculopathy (P = 0.02). In eyes with neovascular AMD, CRT (P = 0.005) and presence of intact ELM (P = 0.007) were significant predictors of 12-month BCVA.

Conclusion: Periodic IVA injection leads to anatomical and functional improvement in eyes with pachychoroid neovasculopathy and in eyes with neovascular AMD.

Keywords: aflibercept; age-related macular degeneration; choroidal thickness; pachychoroid neovasculopathy.

PubMed Disclaimer

Conflict of interest statement

None of the authors has a proprietary interest in any of the products described herein. Dr Manabu Miyata reports personal fees from Santen Pharmaceutical, personal fees from HOYA, grants from Alcon Japan, grants from Novartis Pharma, outside the submitted work. Dr Hiroshi Tamura reports personal fees from Novartis, grants from Findex, and personal fees from Suntory, outside the submitted work. Dr Akio Oishi reports personal fees from Bayer and non-financial support from Tokai Optical, outside the submitted work. The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
Treatment protocol. Intervention schedule for patients with pachychoroid neovasculopathy and neovascular age-related macular degeneration. formula imageAflibercept injection (2 mg); formula imageclinical data collection; formula imageefficacy endpoint.
Figure 2
Figure 2
A case with pachychoroid neovasculopathy (before treatment). Images of the left eye of a 70-year-old man with pachychoroid neovasculopathy without any treatment history. The best-corrected visual acuity was 20/50. (A) Color fundus photograph shows subretinal hemorrhage and serous retinal detachment. Note that drusen are absent. (B) Optical coherence tomography (OCT) angiography image shows choroidal neovascularization (CNV). (C) Late-phase fluorescein angiography image shows leakage suggesting occult CNV. (D) Late-phase indocyanine green angiography image. (E) Enhanced-depth imaging OCT image shows serous retinal detachment and elevation of the retinal pigment epithelium, suggesting CNV. The choroid is thick throughout the macula, and choroidal vessels are dilated. Subfoveal choroidal thickness = 387 μm, central retinal thickness = 317 μm.
Figure 3
Figure 3
A case with pachychoroid neovasculopathy (after treatment). Images of the same patient as in Figure 2, acquired 12 months after initial treatment. The best-corrected visual acuity had improved to 20/16. (A) Color fundus photograph shows resolution of subretinal hemorrhage and serous retinal detachment. (B) Optical coherence tomography (OCT) angiography image shows choroidal neovascularization. (C) Late-phase fluorescein angiography image shows reduction of leakage. (D) Late-phase indocyanine green angiography image. (E) Enhanced-depth imaging OCT image shows resolution of serous retinal detachment. Subfoveal choroidal thickness = 348 μm, central retinal thickness = 206 μm.
See this image and copyright information in PMC

References

    1. Klein ML, Ferris FL, Armstrong J, et al. Retinal precursors and the development of geographic atrophy in age-related macular degeneration. Ophthalmology. 2008;115(6):1026–1031. doi: 10.1016/j.ophtha.2007.08.030 - DOI - PubMed
    1. Brown DM, Kaiser PK, Michels M, et al. Ranibizumab versus verteporfin for neovascular age-related macular degeneration. N Engl J Med. 2006;355(14):1432–1444. doi: 10.1056/NEJMoa062655 - DOI - PubMed
    1. Rosenfeld PJ, Brown DM, Heier JS, et al. Ranibizumab for neovascular age-related macular degeneration. N Engl J Med. 2006;355(14):1419–1431. doi: 10.1056/NEJMoa054481 - DOI - PubMed
    1. Heier JS, Brown DM, Chong V, et al. Intravitreal aflibercept (VEGF trap-eye) in wet age-related macular degeneration. Ophthalmology. 2012;119(12):2537–2548. doi: 10.1016/j.ophtha.2012.09.006 - DOI - PubMed
    1. Brown DM, Michels M, Kaiser PK, et al. Ranibizumab versus verteporfin photodynamic therapy for neovascular age-related macular degeneration: two-year results of the ANCHOR Study. Ophthalmology. 2009;116(1):57–65.e5. doi: 10.1016/j.ophtha.2008.10.018 - DOI - PubMed