One-Year Results of a Treat-and-Extend Regimen of Intravitreal Aflibercept for Polypoidal Choroidal Vasculopathy
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ORIGINAL RESEARCH
One-Year Results of a Treat-and-Extend Regimen of Intravitreal Aflibercept for Polypoidal Choroidal Vasculopathy Tomoko Tamachi . Takeya Kohno . Manabu Yamamoto . Kumiko Hirayama . Akika Kyo . Nobuhiko Ueda . Michiko Hirabayashi . Kunihiko Shiraki . Shigeru Honda
Received: June 5, 2020 / Accepted: October 3, 2020 Ó The Author(s) 2020
ABSTRACT Introduction: To evaluate 1-year outcomes of intravitreal aflibercept (IVA) using a treat-andextend (TAE) regimen for polypoidal choroidal vasculopathy (PCV) and identify the factors for patients whose treatment intervals could be extended. Methods: Fifty-one eyes of treatment-naı¨ve PCV patients treated with IVA using a TAE regimen for at least 1 year were examined retrospectively. All patients received at least three IVA injections every 5 weeks, and the intervals were then extended by 2-week adjustments up to 13 weeks. When retinal exudation recurred, the patient was treated with the same regimen, but with a shortened interval of 5 weeks.The main outcome measures were changes in bestcorrected visual acuity (BCVA) and central retinal thickness (CRT) as well as the treatment interval at 1 year.
T. Tamachi T. Kohno (&) M. Yamamoto K. Hirayama A. Kyo N. Ueda K. Shiraki S. Honda Department of Ophthalmology and Visual Sciences, Osaka City University Graduate School of Medicine, Osaka, Japan e-mail: [email protected] M. Hirabayashi Department of Ophthalmology, Shiraniwa Hospital, Ikoma, Japan
Results: The mean logarithm of the minimum angle of resolution BCVA improved from 0.24 ± 0.32 at baseline to 0.18 ± 0.31 at 12 months (p = 0.048). The mean CRT decreased from 350.3 ± 147.7 lm at baseline to 215.3 ± 75.0 lm at 4 months (p \ 0.001), after which it was maintained at this level. At 12 months, the administration interval was 5 weeks in eight eyes (15.7%), 7 weeks in six eyes (11.8%), 9 weeks in two eyes (3.9%), 11 weeks in four eyes (7.8%), and 13 weeks in 31 eyes (60.8%). Female sex, a thinner CRT at 6 months, and absence of polypoidal lesions at 12 months were significant factors related to patients whose treatment intervals could be extended without recurrence to 13 weeks. Conclusion: IVA using a TAE regimen improved visual and anatomical outcomes in eyes with PCV at 1 year using a protocol to adjust the injection intervals specifically for each patient so as to obtain no retinal exudation. Keywords: Aflibercept; Age-related macular degeneration; Polypoidal choroidal vasculopathy; Treat-and-extend regimen
Ophthalmol Ther
Key Summary Points PCV treatment remains under discussion. Based on two large-scale, clinical, controlled studies, the EVEREST II study and the PLANET study, combination therapy with an anti-VEGF drug and PDT and with intravitreal aflibercept (IVA) monotherapy are seen as the initial treatment strategies for treatment-naı¨ve PCV patients. However, the best treatment regimen that can maintain the improvement achieved during the initial treatment along with a lower clinic and patient burden in routine clinical pract
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