Офтальмохирургия (Dec 2017)

AFLIBERCEPT IN TREATMENT OF RESISTANT POLYPOID CHOROIDAL VASCULOPATHY: SHORT-TERM RESULTS

  • E. K. Pedanova,
  • A. V. Doga,
  • A. M. Mayorova,
  • I. M. Gorshkov,
  • A. A. Voskresenskaya

DOI
https://doi.org/10.25276/0235-4160-2017-4-38-44
Journal volume & issue
Vol. 0, no. 4
pp. 38 – 44

Abstract

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Polypoid choroidal vasculopathy (PCV) is a rare subtype of age-related macular degeneration, characterized by a formation of a branching vascular network (BVN) and polyps. In a number of cases a resistance to the performed therapy was observed in particular using Ranibizumab. In its turn, the angiogenesis inhibitor Aflibercept with a relatively greater affinity for VEGF-A molecules had already demonstrated its efficacy in previously untreated patients with PCV.Purpose. To evaluate the first results of Aflibercept treatment in polypoid choroidal vasculopathy, resistant to a previous combined therapy. Material and methods. The prospective study included 8 patients (9 eyes) with treatment-resistant PCV (three or more intravitreal injections of 0.5mg of Ranibizumab monthly or in combination with photodynamic therapy (PDT) with Chlorin e6). One month after 3 monthly intravitreal injections of 2mg of Aflibercept, changes in visual acuity, central retinal sensitivity (CRS) and central retinal thickness (CRT), a resorption of the subretinal fluid, dome-shaped retinal pigment epithelial detachment, polyps and BVN were evaluated according to the OCT data, OCTangiography, fluorescein angiography (FAG) and indocyanine green angiography (ICGA).Results. Visual acuity before and after treatment did not show the statistically significant difference (0.5±0.2 and 0.6±0.2, respectively, p=0.4). The CRS demonstrated a pronounced positive dynamic from 21.5±2.7 to 24.0±3.7dB (p=0.02). Resorption of the subretinal fluid was noted with a statistically significant decrease in the CRT from 336.3±55.1 to 284.3±60.1µm (p=0.03). Among 6 eyes with dome-shaped RPE detachment, two showed a complete attachment, and three a partial attachment, in one patient the height of retinal detachment increased. According to ICGA, OCT and OCT angiography data, the regression of polyps was detected in 6 of 9 eyes, however, the BVN still persisted.Conclusion. Short-term results of Aflibercept treatment in patients with resistant PCV showed its efficacy in relation to the reduction of exudation, the polyps closure and the increase of central retinal sensitivity.

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