First Author: N.Wadhwa INDIA
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Polypoidal choroidal vasculopathy (PCV) is a variant of choroidal neovascularization and neovascular age related macular degeneration presenting with haemorrhagic and exudative changes within the macula and/or peripapillary region leading to vision loss. Historically, PCV complexes are less responsive to anti-vascular endothelial growth factor therapy. Recently, intravitreal aflibercept has been shown to result in stabilization of vision, resolution of exudative and haemorrhagic complications with regression of polyps in PCV. The aim of our study was to evaluate safety and efficacy of intravitreal Ziv-aflibercept injection (IZI), a similar molecule as aflibercept, in treatment naïve patients suffering from PCV.
Single centre, single surgeon, interventional case series.
In this interventional case series, six treatment naive eyes of six patients with proven PCV were treated with three monthly injections of Ziv-aflibercept (IZI) followed by pro re nata treatment. All the patients were expalined the experimental nature of the treatment and written informed consent taken for the same. Baseline comprehensive ophthalmic examination was done which included measurement of best corrected visual activity (BCVA), fundus fluorescein angiography (FFA), indocyanin green (ICG) angiography , intraocular pressure (IOP) measurements, SD-OCT measurement were done and repeated at each follow up examination. The BCVA converted to the logarithm of the minimum angle of resolution (LogMAR) and central macular thickness (CMT) at each follow-up visit were compared with the baseline values. The anatomic response was also assessed with absorption or reduction of fluid in the subretinal or subpigment epithelial space.
Out of 6 patients enrolled in the study, 4 patients were males while 2 patients were females. The patients were followed up for a mean period of 9.5 ± 2.34 months. The number of intravitreal injections given was 6.7 ± 1.7. At the end of follow up period , all the eyes exhibited complete resolution of subretinal fluid or haemorrhage.While 4 eyes showed regression of polypoidal vessels on fluorescein and ICG angiography, two eyes had incomplete regression of polypoidal vessels. The mean central foveal thickness decreased from 433.5 ± 96.71 µm to 273 ± 39.06 µm (p=0.028, Wilcoxon signed rank test) while Best corrected visual acuity (BCVA) expressed as LogMAR decreased from 0.84 ± 0.22 to 0.41 ± 0.10 (p=0.027, Wilcoxon signed rank test) after treatment.
In this small interventional case series , intravitreal Ziv-aflibercept was shown to result in stabilization or improvement of vision, resolution of exudative and haemorrhagic complications with regression of polyps in significant proportion of patients suffering from PCV. Off label use of IZI can be an effective and safe treatment in patients suffering from PCV, though, long term randomised trials are required to establish its safety and efficacy vis-a-vis other anti-VEGF therapies.