Skip to main content
Top
Published in: Graefe's Archive for Clinical and Experimental Ophthalmology 10/2017

01-10-2017 | Retinal Disorders

Two-year results of a treat-and-extend regimen with aflibercept for polypoidal choroidal vasculopathy

Authors: Masahiro Morimoto, Hidetaka Matsumoto, Kensuke Mimura, Hideo Akiyama

Published in: Graefe's Archive for Clinical and Experimental Ophthalmology | Issue 10/2017

Login to get access

Abstract

Purpose

To evaluate the effects of aflibercept therapy using a treat-and-extend regimen on treatment-naïve polypoidal choroidal vasculopathy (PCV).

Methods

In a retrospective interventional case series of 58 eyes of 58 patients with PCV, we assessed best-corrected visual acuity (BCVA), central macular thickness (CMT), central choroidal thickness (CCT), and number of injections for 2 years. Polypoidal lesions were also evaluated before treatment and after the loading phase by indocyanine green angiography.

Results

BCVA significantly improved after the loading phase and was maintained in the maintenance phase. CMT and CCT significantly reduced after the loading phase and were maintained throughout the follow-up period. The number of injections averaged 7.72 in the first year and 4.67 in the second year. The average number of polypoidal lesions per patient was 2.43 before treatment. In 32 patients (55.2%), polypoidal lesions regressed completely after the loading phase; these patients also needed significantly fewer injections compared to other patients. CCT at baseline was positively correlated with the decreased amount of CCT after 2 years and negatively correlated with the number of injections for 2 years.

Conclusions

Treat-and-extend intravitreal therapy with aflibercept may be effective for improving BCVA and exudative change in eyes with PCV. The regression of polypoidal lesions after the loading phase and thicker choroid at baseline might lead to fewer total number of intravitreal injections of aflibercept.
Literature
1.
go back to reference Yannuzzi LA, Ciardella A, Spaide RF, Rabb M, Freund KB, Orlock DA (1997) The expanding clinical spectrum of idiopathic polypoidal choroidal vasculopathy. Arch Ophthalmol 115(4):478–485CrossRefPubMed Yannuzzi LA, Ciardella A, Spaide RF, Rabb M, Freund KB, Orlock DA (1997) The expanding clinical spectrum of idiopathic polypoidal choroidal vasculopathy. Arch Ophthalmol 115(4):478–485CrossRefPubMed
5.
go back to reference Brown DM, Kaiser PK, Michels M, Soubrane G, Heier JS, Kim RY, Sy JP, Schneider S (2006) Ranibizumab versus verteporfin for neovascular age-related macular degeneration. N Engl J Med 355(14):1432–1444. doi:10.1056/NEJMoa062655 CrossRefPubMed Brown DM, Kaiser PK, Michels M, Soubrane G, Heier JS, Kim RY, Sy JP, Schneider S (2006) Ranibizumab versus verteporfin for neovascular age-related macular degeneration. N Engl J Med 355(14):1432–1444. doi:10.​1056/​NEJMoa062655 CrossRefPubMed
6.
go back to reference Lalwani GA, Rosenfeld PJ, Fung AE, Dubovy SR, Michels S, Feuer W, Davis JL, Flynn HW Jr, Esquiabro M (2009) A variable-dosing regimen with intravitreal ranibizumab for neovascular age-related macular degeneration: year 2 of the PrONTO study. Am J Ophthalmol 148(1):43–58 e41. doi:10.1016/j.ajo.2009.01.024 CrossRefPubMed Lalwani GA, Rosenfeld PJ, Fung AE, Dubovy SR, Michels S, Feuer W, Davis JL, Flynn HW Jr, Esquiabro M (2009) A variable-dosing regimen with intravitreal ranibizumab for neovascular age-related macular degeneration: year 2 of the PrONTO study. Am J Ophthalmol 148(1):43–58 e41. doi:10.​1016/​j.​ajo.​2009.​01.​024 CrossRefPubMed
7.
go back to reference Singer MA, Awh CC, Sadda S, Freeman WR, Antoszyk AN, Wong P, Tuomi L (2012) HORIZON: an open-label extension trial of ranibizumab for choroidal neovascularization secondary to age-related macular degeneration. Ophthalmology 119(6):1175–1183. doi:10.1016/j.ophtha.2011.12.016 CrossRefPubMed Singer MA, Awh CC, Sadda S, Freeman WR, Antoszyk AN, Wong P, Tuomi L (2012) HORIZON: an open-label extension trial of ranibizumab for choroidal neovascularization secondary to age-related macular degeneration. Ophthalmology 119(6):1175–1183. doi:10.​1016/​j.​ophtha.​2011.​12.​016 CrossRefPubMed
12.
go back to reference Koh A, Lee WK, Chen LJ, Chen SJ, Hashad Y, Kim H, Lai TY, Pilz S, Ruamviboonsuk P, Tokaji E, Weisberger A, Lim TH (2012) EVEREST study: efficacy and safety of verteporfin photodynamic therapy in combination with ranibizumab or alone versus ranibizumab monotherapy in patients with symptomatic macular polypoidal choroidal vasculopathy. Retina 32(8):1453–1464. doi:10.1097/IAE.0b013e31824f91e8 CrossRefPubMed Koh A, Lee WK, Chen LJ, Chen SJ, Hashad Y, Kim H, Lai TY, Pilz S, Ruamviboonsuk P, Tokaji E, Weisberger A, Lim TH (2012) EVEREST study: efficacy and safety of verteporfin photodynamic therapy in combination with ranibizumab or alone versus ranibizumab monotherapy in patients with symptomatic macular polypoidal choroidal vasculopathy. Retina 32(8):1453–1464. doi:10.​1097/​IAE.​0b013e31824f91e8​ CrossRefPubMed
13.
go back to reference Hikichi T, Higuchi M, Matsushita T, Kosaka S, Matsushita R, Takami K, Ohtsuka H, Ariga H (2012) One-year results of three monthly ranibizumab injections and as-needed reinjections for polypoidal choroidal vasculopathy in Japanese patients. Am J Ophthalmol 154(1):117–124 e111. doi:10.1016/j.ajo.2011.12.019 CrossRefPubMed Hikichi T, Higuchi M, Matsushita T, Kosaka S, Matsushita R, Takami K, Ohtsuka H, Ariga H (2012) One-year results of three monthly ranibizumab injections and as-needed reinjections for polypoidal choroidal vasculopathy in Japanese patients. Am J Ophthalmol 154(1):117–124 e111. doi:10.​1016/​j.​ajo.​2011.​12.​019 CrossRefPubMed
14.
15.
go back to reference Gomi F, Oshima Y, Mori R, Kano M, Saito M, Yamashita A, Iwata E, Maruko R (2015) INITIAL VERSUS DELAYED PHOTODYNAMIC THERAPY IN COMBINATION WITH RANIBIZUMAB FOR TREATMENT OF POLYPOIDAL CHOROIDAL VASCULOPATHY: the Fujisan study. Retina 35(8):1569–1576. doi:10.1097/IAE.0000000000000526 CrossRefPubMed Gomi F, Oshima Y, Mori R, Kano M, Saito M, Yamashita A, Iwata E, Maruko R (2015) INITIAL VERSUS DELAYED PHOTODYNAMIC THERAPY IN COMBINATION WITH RANIBIZUMAB FOR TREATMENT OF POLYPOIDAL CHOROIDAL VASCULOPATHY: the Fujisan study. Retina 35(8):1569–1576. doi:10.​1097/​IAE.​0000000000000526​ CrossRefPubMed
16.
17.
19.
go back to reference Hosokawa M, Morizane Y, Hirano M, Kimura S, Kumase F, Shiode Y, Doi S, Toshima S, Hosogi M, Fujiwara A, Mitsuhashi T, Shiraga F (2016) One-year outcomes of a treat-and-extend regimen of intravitreal aflibercept for polypoidal choroidal vasculopathy. Jpn J Ophthalmol. doi:10.1007/s10384-016-0492-7 Hosokawa M, Morizane Y, Hirano M, Kimura S, Kumase F, Shiode Y, Doi S, Toshima S, Hosogi M, Fujiwara A, Mitsuhashi T, Shiraga F (2016) One-year outcomes of a treat-and-extend regimen of intravitreal aflibercept for polypoidal choroidal vasculopathy. Jpn J Ophthalmol. doi:10.​1007/​s10384-016-0492-7
20.
go back to reference Kikushima W, Sakurada Y, Sugiyama A, Tanabe N, Kume A, Iijima H (2017) Comparison of initial treatment between 3-monthly intravitreal aflibercept monotherapy and combined photodynamic therapy with single intravitreal aflibercept for polypoidal choroidal vasculopathy. Graefes Arch Clin Exp Ophthalmol 255(2):311–316. doi:10.1007/s00417-016-3467-y CrossRefPubMed Kikushima W, Sakurada Y, Sugiyama A, Tanabe N, Kume A, Iijima H (2017) Comparison of initial treatment between 3-monthly intravitreal aflibercept monotherapy and combined photodynamic therapy with single intravitreal aflibercept for polypoidal choroidal vasculopathy. Graefes Arch Clin Exp Ophthalmol 255(2):311–316. doi:10.​1007/​s00417-016-3467-y CrossRefPubMed
22.
go back to reference Koizumi H, Kano M, Yamamoto A, Saito M, Maruko I, Sekiryu T, Okada AA, Iida T (2016) Subfoveal choroidal thickness during Aflibercept therapy for Neovascular age-related macular degeneration: twelve-month results. Ophthalmology 123(3):617–624. doi:10.1016/j.ophtha.2015.10.039 CrossRefPubMed Koizumi H, Kano M, Yamamoto A, Saito M, Maruko I, Sekiryu T, Okada AA, Iida T (2016) Subfoveal choroidal thickness during Aflibercept therapy for Neovascular age-related macular degeneration: twelve-month results. Ophthalmology 123(3):617–624. doi:10.​1016/​j.​ophtha.​2015.​10.​039 CrossRefPubMed
25.
go back to reference Japanese study group of polypoidal choroidal vasculopathy (2005) Criteria for diagnosis of polypoidal choroidal vasculopathy [in Japanese, with English abstract]. Nippon Gannka Gakkai Zasshi 109:417–427 Japanese study group of polypoidal choroidal vasculopathy (2005) Criteria for diagnosis of polypoidal choroidal vasculopathy [in Japanese, with English abstract]. Nippon Gannka Gakkai Zasshi 109:417–427
26.
27.
go back to reference Yanai H (2015) Statcel- the useful add-in software forms on excel, 4th edn. OMS, Tokyo Yanai H (2015) Statcel- the useful add-in software forms on excel, 4th edn. OMS, Tokyo
28.
go back to reference Patel KH, Chow CC, Rathod R, Mieler WF, Lim JI, Ulanski LJ 2nd, Leiderman YI, Arun V, Chau FY (2013) Rapid response of retinal pigment epithelial detachments to intravitreal aflibercept in neovascular age-related macular degeneration refractory to bevacizumab and ranibizumab. Eye (Lond) 27(5):663–667; quiz 668. doi:10.1038/eye.2013.31 CrossRef Patel KH, Chow CC, Rathod R, Mieler WF, Lim JI, Ulanski LJ 2nd, Leiderman YI, Arun V, Chau FY (2013) Rapid response of retinal pigment epithelial detachments to intravitreal aflibercept in neovascular age-related macular degeneration refractory to bevacizumab and ranibizumab. Eye (Lond) 27(5):663–667; quiz 668. doi:10.​1038/​eye.​2013.​31 CrossRef
30.
32.
go back to reference Gianniou C, Dirani A, Ferrini W, Marchionno L, Decugis D, Deli A, Ambresin A, Mantel I (2015) Two-year outcome of an observe-and-plan regimen for neovascular age-related macular degeneration: how to alleviate the clinical burden with maintained functional results. Eye (Lond) 29(3):342–349. doi:10.1038/eye.2014.258 CrossRef Gianniou C, Dirani A, Ferrini W, Marchionno L, Decugis D, Deli A, Ambresin A, Mantel I (2015) Two-year outcome of an observe-and-plan regimen for neovascular age-related macular degeneration: how to alleviate the clinical burden with maintained functional results. Eye (Lond) 29(3):342–349. doi:10.​1038/​eye.​2014.​258 CrossRef
35.
go back to reference Usui S, Ikuno Y, Akiba M, Maruko I, Sekiryu T, Nishida K, Iida T (2012) Circadian changes in subfoveal choroidal thickness and the relationship with circulatory factors in healthy subjects. Invest Ophthalmol Vis Sci 53(4):2300–2307. doi:10.1167/iovs.11-8383 CrossRefPubMed Usui S, Ikuno Y, Akiba M, Maruko I, Sekiryu T, Nishida K, Iida T (2012) Circadian changes in subfoveal choroidal thickness and the relationship with circulatory factors in healthy subjects. Invest Ophthalmol Vis Sci 53(4):2300–2307. doi:10.​1167/​iovs.​11-8383 CrossRefPubMed
Metadata
Title
Two-year results of a treat-and-extend regimen with aflibercept for polypoidal choroidal vasculopathy
Authors
Masahiro Morimoto
Hidetaka Matsumoto
Kensuke Mimura
Hideo Akiyama
Publication date
01-10-2017
Publisher
Springer Berlin Heidelberg
Published in
Graefe's Archive for Clinical and Experimental Ophthalmology / Issue 10/2017
Print ISSN: 0721-832X
Electronic ISSN: 1435-702X
DOI
https://doi.org/10.1007/s00417-017-3718-6

Other articles of this Issue 10/2017

Graefe's Archive for Clinical and Experimental Ophthalmology 10/2017 Go to the issue