Mariko Kano

One-Year Results of Intravitreal Aflibercept for Polypoidal Choroidal Vasculopathy

PURPOSE To investigate 1-year outcomes of intravitreal aflibercept for polypoidal choroidal vasculopathy (PCV). DESIGN Retrospective, multicenter, consecutive case series. PARTICIPANTS A total of 90 eyes of 87 patients with treatment-naïve PCV followed at 3 tertiary centers. METHODS Clinical records were reviewed and imaging studies were analyzed of eyes with PCV that underwent 3 consecutive monthly aflibercept injections followed by injections every 2 months. Additional (rescue) injections were performed for worsening. MAIN OUTCOME MEASURES Best-corrected visual acuity (BCVA), optical coherence tomography (OCT), and angiographic findings at 1 year. RESULTS The mean BCVA (logarithm of the minimum angle of resolution units) of the 90 eyes improved from 0.31 at baseline to 0.17 at 12 months (P < 0.001). The mean central retinal thickness decreased from 315 μm at baseline to 204 μm at 12 months (P < 0.001). At 12 months, 64 eyes (71.1%) achieved a dry macula, defined as absence of intraretinal or subretinal fluid on OCT. Of 83 eyes that underwent indocyanine green angiography at both baseline and 12 months, 46 (55.4%) showed complete and 27 (32.5%) showed partial resolution of polypoidal lesions. Eleven of 82 eyes (13.4%) showed decreased size of branching choroidal vascular networks. CONCLUSIONS Intravitreal aflibercept administered over 1 year improved both visual acuity and macular morphology in a large number of treatment-naïve eyes with PCV.

Subfoveal Choroidal Thickness during Aflibercept Therapy for Neovascular Age-Related Macular Degeneration: Twelve-Month Results

PURPOSE To investigate changes in subfoveal choroidal thickness after intravitreal aflibercept injections (IAIs) for neovascular age-related macular degeneration (AMD) at 12 months. DESIGN Retrospective, consecutive, interventional case series. PARTICIPANTS One hundred forty-four patients with treatment-naïve neovascular AMD examined at 3 university hospitals. METHODS After a loading phase of 3 monthly 2.0-mg IAIs, the patients were injected bimonthly with additional rescue injections performed for worsening. Subfoveal choroidal thickness in IAI-treated eyes was evaluated using enhanced depth imaging optical coherence tomography (OCT) or swept-source OCT. MAIN OUTCOME MEASURES Changes in subfoveal choroidal thickness over a 12-month period. RESULTS Of the 144 treated eyes, 58 (40.3%) had typical neovascular AMD and 86 (59.7%) had polypoidal choroidal vasculopathy (PCV). The mean subfoveal choroidal thickness of treated eyes decreased from 268.1±101.3 μm at baseline to 233.0±99.7 μm at 3 months and remained unchanged at 232.4±99.6 μm at 12 months (percentage decrease, 13.3% at 12 months compared with baseline; P < 0.0001), although there was some fluctuation in between treatments. This decrease in subfoveal choroidal thickness was associated significantly with gain in visual acuity for PCV eyes (P = 0.0087; R = 0.28), but not for eyes with typical neovascular AMD (P = 0.17; R = 0.18). Eyes without persistent or recurrent retinal fluid after the loading phase showed greater decrease in subfoveal choroidal thickness compared with those with persistent or recurrent retinal fluid, in both typical neovascular AMD (P = 0.042) and PCV (P = 0.038) eyes. CONCLUSIONS Subfoveal choroidal thickness decreased over 12 months with IAI therapy in eyes with neovascular AMD. Changes in subfoveal choroidal thickness after IAIs seem to be related to visual and anatomic outcomes.

Intravitreal ranibizumab for polypoidal choroidal vasculopathy with recurrent or residual exudation.

Purpose: To clarify the efficiency of ranibizumab for polypoidal choroidal vasculopathy in patients with regressed polypoidal lesions after previous photodynamic therapy (PDT) applications but recurrent or residual exudation from branching vascular network vessels. Methods: We retrospectively reviewed 59 eyes of 59 Japanese patients (47 men and 12 women) with polypoidal choroidal vasculopathy. Treatments were chosen according to the period. Thirty-four patients were treated with PDT (PDT group) and 25 patients were treated with intravitreal injections of ranibizumab (ranibizumab group). Results: In the ranibizumab group, the mean best-corrected visual acuity levels at baseline and 6 months were 0.27 and 0.41, respectively, showing a significant (P < 1× 10−5) improvement from baseline. In the PDT group, the mean best-corrected visual acuity levels at baseline and 6 months were 0.29 and 0.24, respectively, showing a significant (P < 0.01) decline from baseline. The mean numbers of treatments at 6 months in the ranibizumab and the PDT groups were 3.6 and 1.4, respectively. A subretinal hemorrhage (>1 disk diameter) developed in 5 eyes in the PDT group. Conclusion: Intravitreal ranibizumab is an effective treatment for maintaining or improving visual acuity and the anatomical changes in patients with polypoidal choroidal vasculopathy with recurrent or residual exudation from branching vascular network vessels.

INITIAL VERSUS DELAYED PHOTODYNAMIC THERAPY IN COMBINATION WITH RANIBIZUMAB FOR TREATMENT OF POLYPOIDAL CHOROIDAL VASCULOPATHY: The Fujisan Study.

Purpose: To compare the 1-year results of initial or deferred photodynamic therapy (PDT) combined with intravitreal ranibizumab (IVR) for eyes with polypoidal choroidal vasculopathy. Methods: Prospectively, 72 men with treatment-naive polypoidal choroidal vasculopathy were randomized to initial or later PDT combined with IVR. In both groups, 2 additional monthly IVR followed. From Month 3, PDT and IVR were administered according to the retreatment criteria. Mean changes in the best-corrected visual acuity between baseline and Month 12 and central retinal thickness, the rate of eyes showing regression of polypoidal lesions, and number of additional treatments were compared. Results: The best-corrected visual acuity increased by a mean of 8.1 Early Treatment of Diabetic Retinopathy Study (ETDRS) letters in the initial PDT group and 8.8 ETDRS letters in the later PDT group, and there was a no significant difference (P = 0.59). The mean central retinal thickness decreased significantly in both groups but more so with combination therapy within the first 4 months; the difference was not significant at Month 12 (P = 0.30). The rate of eyes showing resolution of polypoidal lesions at 12 months was 62.1% in the initial PDT group and 54.8% in the later PDT group and again, there was no significant difference (P = 0.53). The mean number of additional IVR was 1.5 in initial PDT and 3.8 in later PDT; that of additional PDTs was 0.14 and 0.45, respectively, and they were significantly different (P < 0.001 and P = 0.013, respectively). Conclusion: Both initial and deferred PDT combined with IVR to treat polypoidal choroidal vasculopathy show the similar visual and anatomical improvements at 12 months. Initial PDT combination leads to significantly fewer additional treatments.

Switching To Intravitreal Aflibercept Injection For Polypoidal Choroidal Vasculopathy Refractory To Ranibizumab

Purpose: To clarify the efficacy of switching to intravitreal aflibercept injection to treat polypoidal choroidal vasculopathy refractory to ranibizumab. Methods: In this retrospective study, 43 eyes of 42 patients (mean age, 76.5 years) with polypoidal choroidal vasculopathy treated with aflibercept (2 mg/0.05 mL) were reviewed. A treatment history of 3 consecutive monthly intravitreal injections of ranibizumab as an induction phase followed by a pro re nata maintenance phase over 12 months was seen for all patients. All patients who were refractory to ranibizumab (defined as having persist subretinal or intraretinal fluid by optical coherence tomography and unchanged or decreased visual acuity compared with the time of the first ranibizumab injection, despite receiving the last 3 consecutive monthly intravitreal ranibizumab injections after 12 months). Results: The mean logarithm of the minimum angle of resolution best-corrected visual acuity levels (Snellen equivalent) improved significantly (P = 0.0074) from 0.38 (20/48) at baseline to 0.34 (20/43) 3 months after switching to aflibercept (Month 3) (mean best-corrected visual acuity improvement, 0.47 line). The central retinal thickness decreased significantly (P < 0.0001) from 245 &mgr;m at baseline to 131 &mgr;m at Month 3. Of 30 eyes with polypoidal lesions at baseline, the polypoidal lesions regressed completely in 15 eyes (50%) at Month 3. Conclusion: Administering intravitreal aflibercept injection for patients with polypoidal choroidal vasculopathy refractory to ranibizumab maintained or improved visual acuity and reduced or eliminated exudative lesions and occluding polypoidal lesions without adverse events with short-term follow-up.

Comparison of Intravitreal Triamcinolone Acetonide With Photodynamic Therapy and Intravitreal Bevacizumab with Photodynamic Therapy for Retinal Angiomatous Proliferation

PURPOSE To compare the efficacy of combined therapy with intravitreal triamcinolone (IVTA) and photodynamic therapy (PDT; IVTA plus PDT) with intravitreal bevacizumab (IVB) and PDT (IVB plus PDT) for patients with retinal angiomatous proliferation (RAP). DESIGN Retrospective, observational case series. METHODS We retrospectively reviewed 25 treatment-naïve eyes of 22 Japanese patients (11 men, 11 women) with retinal angiomatous proliferation. Twelve eyes of 11 patients were treated with combined therapy of IVTA plus PDT from September 1, 2004, through July 31, 2006. Thirteen eyes of 11 patients were treated with combined therapy of IVB plus PDT from February 1, 2007, through January 31, 2008. RESULTS In 12 eyes treated with IVTA plus PDT, the mean best-corrected visual acuity (BCVA) levels at baseline and 12 months were 0.29 and 0.13, respectively. A significant (P < .05) decline in the mean BCVA from baseline was observed at 12 months. In 13 eyes treated with IVB plus PDT, the mean BCVA levels at baseline and 12 months were 0.25 and 0.37. A significant (P < .05) improvement in the mean BCVA from baseline was observed. At 12 months, the difference in BCVA between the 2 groups was significant (P < .05). The mean numbers of treatments at 12 months in the IVTA plus PDT group and the IVB plus PDT group were 2.7 and 1.6, respectively. The difference between the 2 treatments reached significance (P < .05). No complications developed. CONCLUSIONS Compared with IVTA plus PDT, IVB plus PDT was significantly more effective in maintaining and improving visual acuity and in reducing the number of treatment for patients with retinal angiomatous proliferation.

Aflibercept therapy for polypoidal choroidal vasculopathy: short-term results of a multicentre study

Background/aims To investigate short-term outcomes of intravitreal aflibercept injections (IAIs) for polypoidal choroidal vasculopathy (PCV). Methods 91 eyes of 88 consecutive patients with treatment-naive PCV examined at three university hospitals received IAI monthly for 3 months. One month after the third IAI, changes in best-corrected visual acuity (BCVA) and macular morphology were retrospectively evaluated. Additionally, possible baseline characteristics predictive of persistent retinal fluid were analysed. Results The mean BCVA (logarithm of the minimum angle of resolution units) of the 91 eyes improved from 0.31 at baseline to 0.21 at 3 months (p<0.0001). The mean central retinal thickness and mean subfoveal choroidal thickness decreased from 323 μm and 270 μm at baseline to 185 μm and 232 μm at 3 months, respectively (p<0.0001 for both). Seventy-three eyes (80.2%) achieved a dry macula defined as absence of retinal fluid. Presence of the baseline characteristics of subretinal haemorrhage and greater size of the largest polyp were significantly associated with inability to achieve a dry macula (p=0.008 and 0.03, respectively). However, this association was not found on multivariate logistic regression. Of the 90 eyes that underwent indocyanine green angiography at 3 months, 43 eyes (47.8%) showed complete and 28 eyes (31.1%) showed partial resolution of polyps. Twenty-four eyes (24.4%) also showed partial regression of branching choroidal vascular networks. Conclusions IAIs for the treatment of a large number of PCV eyes were found to improve both visual acuity and macular morphology over the short term.

Retinal pigment epithelium tear after intravitreal aflibercept injection

To report a case complicated with a retinal pigment epithelium (RPE) tear after intravitreal aflibercept injection. A 78-year-old man had deteriorated visual acuity in his left eye. Fluorescein angiography showed occult choroidal neovascularization. Optical coherence tomography showed a serous retinal detachment and fibrovascular pigment epithelial detachment. He was diagnosed as typical age-related macular degeneration associated with pigment epithelial detachment and treatment consisting of three consecutive monthly intravitreal injections of aflibercept was planned. A month after the initial injection, his visual acuity had not improved. The red-free photograph showed an area of RPE defect inferior to the fovea. The fundus autofluorescence, fluorescein angiography, and optical coherence tomography clearly demonstrated the presence of an RPE tear. A second injection of aflibercept was performed due to a remaining serous retinal detachment. Although this is a single case and RPE tears may occur as a spontaneous complication of age-related macular degeneration patients, the risk of a tear should be discussed when considering aflibercept treatment for typical age-related macular degeneration patients with pigment epithelial detachment as there might be a risk for developing an RPE tear.

Intravitreal ranibizumab for exudative age-related macular degeneration with good baseline visual acuity.

Purpose: To clarify the efficacy of ranibizumab for treating age-related macular degeneration in patients with baseline visual acuity exceeding 20/40. Methods: We retrospectively reviewed 40 eyes of Japanese patients with age-related macular degeneration (32 men, 8 women) treated with intravitreal injections of ranibizumab (0.5 mg/0.05 mL) (ranibizumab group). We compared the results with observation of 52 eyes (control group). All patients were followed-up for at least 12 months. Results: In the ranibizumab group, the mean logarithm of the minimum angle of resolution best-corrected visual acuity (Snellen equivalent) with typical age-related macular degeneration (22 eyes) and polypoidal choroidal vasculopathy (18 eyes) statistically significantly (P < 0.0001, P = 0.015, respectively) improved from 0.17 (20/29) and 0.14 (20/28) at baseline to 0.07 (20/24) and 0.07 (20/24) at Month 12, respectively (mean numbers of treatments, 4.6 and 4.9). The central retinal thickness decreased from 262 ± 105 &mgr;m at baseline to 187 ± 62 &mgr;m at Month 12 in the ranibizumab group. In the control group, the mean logarithm of the minimum angle of resolution best-corrected visual acuity in eyes with typical age-related macular degeneration (19 eyes) and polypoidal choroidal vasculopathy (33 eyes) statistically significant (P = 0.017, P = 0.023, respectively) declined from 0.08 (20/24) and 0.10 (20/25) at baseline to 0.18 (20/30) and 0.23 (20/34) at Month 12, respectively. Conclusion: Intravitreal ranibizumab maintained or improved visual acuity and anatomic changes in patients with age-related macular degeneration with better than 20/40 visual acuity.

Combined intravitreal ranibizumab and photodynamic therapy for polypoidal choroidal vasculopathy.

Purpose: To clarify the efficacy of combined therapy with intravitreal ranibizumab injections and photodynamic therapy in patients with symptomatic polypoidal choroidal vasculopathy. Methods: We retrospectively reviewed 28 naive eyes of 28 patients (17 men, 11 women; mean age, 73.4 years; range, 55–85 years) with 20/40 or less baseline visual acuity treated with 3 consecutive monthly intravitreal injections of ranibizumab (0.5 mg/0.05 mL) and photodynamic therapy and followed-up for at least 12 months. Photodynamic therapy was administered 1 day or 2 days after the initial injection of ranibizumab. Results: The mean best-corrected visual acuity levels significantly (P < 0.0001) improved from 0.33 at baseline to 0.61 at 12 months. The mean improvement in best-corrected visual acuity 12 months from baseline was 2.65 lines. The best-corrected visual acuity at 12 months improved in 15 eyes (53.6%) by ≥3 lines and was stable (defined as a loss of <3 lines of vision) in 13 eyes (46.4%). The central retinal thickness significantly (P < 0.0001) decreased from 366 µm to 151 µm at 12 months. The mean numbers of photodynamic therapy treatments and injections during 12 months including the treatments during the initial regimen were 1.1 and 3.7, respectively. No complications developed. Conclusion: Combined intravitreal ranibizumab and photodynamic therapy for polypoidal choroidal vasculopathy maintained or improved visual acuity and reduced the exudation without adverse events.