High‑dose aflibercept injection has striking effects on myopic choroidal neovascularization

Abstract

The aim of the present study was to evaluate the 1-year outcomes of a high-dose aflibercept injection [4 mg 2+ pro re nata (PRN) scheme] for individuals with myopic choroidal neovascularization (mCNV) through optical coherence tomography (OCT) follow-ups. A total of 16 consecutive patients (7 males and 9 females; sixteen eyes) with mCNV were enrolled in this retrospective study. The mean age was 30.5±3.35 years and mean spherical equivalent was -7.31±0.90 D. Subjects received 4 mg aflibercept intravitreal injection on the day of diagnosis and 35 days later. Further injections of aflibercept were required when the following were detected by OCT and fluorescein angiography: i) Decrease in best corrected visual acuity (BCVA); ii) aggravation of metamorphopsia; iii) macular oedema; iv) macular haemorrhage; v) increase in retinal thickness; and vi) leakage. Ophthalmic examination and OCT were performed at the baseline, as well as at 1, 2, 4, 6, 8, 10 and 12 months after the initial aflibercept injection. BCVA and central retinal thickness (CRT) were evaluated at each follow-up. The results showed that the vision of all subjects improved following the aflibercept intravitreal injection. The mean BCVA improved from 0.35±0.15 logarithm of the minimal angle of resolution (logMAR) at the baseline to 0.12±0.05 logMAR at final follow-up (P<0.05). A reduction in metamorphopsia was observed and the mean CRT was reduced from 345.38±34.69 µm of pre-treatment levels to 222.75±8.98 µm at the last postoperative visit (P<0.05). The mean number of injections in the present study was 2.13±0.5. Out of all patients, 13 received two injections and 3 subjects received three injections. The mean follow-up was 13.41±1.17 months. Based on the outcomes, it was found that an intravitreal injection of high-dose aflibercept (4 mg 2+PRN scheme) is effective for vision improvement and stabilization. In addition, it also significantly alleviated metamorphopsia and reduced the CRT in patients treated with mCNV. During the follow-up, the eyesight of the patients was stable.

Keywords: aflibercept; anti-vascular endothelial growth factor; choroidal neovascularization; optical coherence tomography; pathologic myopia.

Figure 1

BCVA changes following treatment with high-dose aflibercept. BCVA was significantly improved after treatment and remained stable during the 12-month follow-up. ^*P<0.05 vs. baseline. ^#P<0.05 vs. 1 month. BCVA, best-corrected visual acuity.

Figure 2

CRT changes following treatment with high-dose aflibercept. The CRT decreased significantly in the first 4 months after treatment and remained stable until the end of the 12-month follow-up. ^*P<0.05 vs. baseline; ^#P<0.05 vs. 1 month; ^$P<0.05 vs. 2 months; and ^ΔP<0.05 vs. 6 months. CRT, central retinal thickness.

Figure 3

OCT changes of a representative patient diagnosed with myopic choroidal neovascularization during the follow-up. (A) At diagnosis, OCT indicated fibrovascular pigment epithelial detachment and increased retinal thickness in the fovea. (B) At 1 month after the initial injection, OCT revealed that the fibrovascular pigment epithelial detachment partially retreated and the retinal thickness decreased. A strong dot reflection is seen at the top. OCT at (C) 2, (D) 4, (E) 6, (F) 8 and (G) 12 months after initial aflibercept injection. The distance of pigment epithelial detachment gradually decreased until it returned to normal. The magnification was 1:1. OCT, optical coherence tomography; N, nasal; T, temporal.