First Author: E.Cervera Taulet SPAIN
Co Author(s): V. Castro Navarro J. Montero-Hernandez C. Navarro-Palop C. Chiarri-Toumit
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Although traditionally prospective treatment trials in exudative- age- related macular degeneration (AMD) have not included pigment epithelial detachment (PED) as a protocol retreatment criteria, recent studies have related its presence with higher rates of reactivations and recurrences in neovascular lesions associated to AMD. Our objective is to analyze PED changes in frequency and height among different subtypes of choroidal neovascularizations treated with aflibercept according to a treat- and -extend (TAE) regimen and to correlate the changes with visual gains.
Retrospective nonrandomized cohort study. Thirty-seven eyes of patients with exudative-naive- AMD; 11 classic CNV, 12 occult CNV, 7 mixed CNV and 8 retinal angiomatous proliferations (RAP) lesions were analyzed.
Patients were treated with three monthly 2 mg aflibercept injections followed by a TAE approach. According the multimodal in vivo imaging classification proposed by Freund and build on Donald Gass’ histologic classification the study group was divided into four subgroups according to the : a) type 1 CNV, b) type 2 CNV c) a mixed typical subfoveal choroidal membrane lesions and d) the RAP group. Main outcome measures included changes in best-corrected-visual acuity (BCVA) and quantitative analysis with Spectral-domain optical coherence tomography (SD-OCT) of PED in each subtype of CNV was recorded at baseline, at 3 months, at 6 months and at 12 months. PED was classified into serous-vascularized and fibrovascular. PED height was defined as the distance between the outer border of the retinal pigment epithelium (RPE) and the inner border of the Bruch membrane and it was manually measured at its maximum height, at the fovea and at 500µ centreed on fovea. Statistical significance was defined as (p<0.05).
Patients received a mean of 7.89±1.22 aflibercept injections. Regarding functional outcomes, BCVA significantly improved 0.60 ± 0.27 LogMAR to 0.40 ± 0.34 LogMAR. Baseline percentage of PEDs in each subtype of CNV was 75% in type 1 CNV (n=6 serousvascularized-PEDs and n=3 fibrovascular-PEDs), 36.3 % in type 2 CNV (n=3 serousvascularized-PEDs and n=1 fibrovascular-PED), 83.3% in mixed CNV (n=3 serousvascularized-PEDs and n=2 fibrovascular-PEDs) and 87.5% in RAP(n=6 serousvascularized-PEDs and n=1 fibrovascular-PED). PEDs frequency decreased with treatment in all subtypes with final rates of 16.6% in type 1 CNV (n=2 fibrovascular-PEDs), 18.1% in type 2 CNV (n=2 fibrovascular-PEDs), 33.3% in mixed CNV (n=1 serousvascularized-PED and n=1 fibrovascular-PED) and 50% in RAP (n=4 fibrovascular-PEDs). At baseline, PEDs height was higher in RAP lesions followed by mixed CNV. At the final visit, the greatest PEDs height was found in mixed lesions. In the general cohort, PEDs height significantly decreased at its maximum height at 6 months and at 12 months examinations (p=0.021 and p=0.001), respectively. A correlation between PEDs height and visual gain was found (p=0.005)
According to our results, the presence of PED in naive-CNV was more frequent in RAP, mixed CNV and type 1 CNV. Serous-vascularized PEDs were more frequently seen at baseline, and an increase in fibrovascular-PEDs frequency was found during the treatment. Although at deadline PEDs persisted in 50% of RAP lesions, a TAE approach with aflibercept seems to be an effective approach for reducing PEDs rates and PEDs height in all subtypes of CNV. A significant reduction in PEDs height is seen after 6 and 12 months of treatment which can be essential for visual prognosis as it seems to correlate with visual outcomes.