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Okada AA, Takahashi K, Ohji M, Moon SC, Machewitz T, Sasaki K. Efficacy and Safety of Intravitreal Aflibercept Treat-and-Extend Regimens in the ALTAIR Study: 96-Week Outcomes in the Polypoidal Choroidal Vasculopathy Subgroup. Adv Ther 2022; 39:2984-2998. [PMID: 35503499 PMCID: PMC9123052 DOI: 10.1007/s12325-022-02162-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 04/08/2022] [Indexed: 11/25/2022]
Abstract
Introduction To explore the efficacy and safety of intravitreal aflibercept (IVT-AFL) proactive, individualized treat-and-extend (T&E) regimens in exudative age-related macular degeneration (AMD) in the subgroup of patients with polypoidal choroidal vasculopathy (PCV) enrolled in the ALTAIR study. Methods This was a PCV subgroup analysis of ALTAIR, a 96-week, randomized, open-label, phase 4 study in treatment-naïve patients with exudative AMD in Japan. Following three initial monthly doses, patients received IVT-AFL at week 16 and were randomized 1:1 to T&E regimens with either 2-week (IVT-AFL-2W) or 4-week (IVT-AFL-4W) adjustments. The primary endpoint of ALTAIR was the mean change in best-corrected visual acuity (BCVA) from baseline to week 52. Endpoints were assessed at weeks 52 and 96. Safety analyses were conducted. Results A total of 90 patients with PCV were included within the full analysis set. From baseline to week 52, mean [standard deviation (SD)] change in BCVA was + 7.5 (14.7) letters and + 8.2 (11.6) letters in the IVT-AFL-2W and IVT-AFL-4W groups, respectively. From baseline to week 96, 91.3% and 90.9% of patients maintained vision in the IVT-AFL-2W and IVT-AFL-4W groups, respectively. From baseline to week 52, mean (SD) change in central retinal thickness was − 153 (177) µm and −112 (122) µm in the IVT-AFL-2W and IVT-AFL-4W groups, respectively. Overall, 51.1% of patients (IVT-AFL-2W, 43.5%; IVT-AFL-4W, 59.1%) achieved a treatment interval of 16 weeks between weeks 16 and 96. The safety profile of IVT-AFL was consistent with previous studies. Conclusion In treatment-naïve patients with PCV, IVT-AFL administered using two different T&E regimens improved and maintained functional and anatomic outcomes over 96 weeks while minimizing treatment burden. Trial registration ClinicalTrials.gov identifier, NCT02305238. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-022-02162-w.
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Affiliation(s)
- Annabelle A Okada
- Department of Ophthalmology, Kyorin University School of Medicine, 6-20-2, Shinkawa, Mitaka, Tokyo, 181-8611, Japan.
| | - Kanji Takahashi
- Department of Ophthalmology, Kansai Medical University, Osaka, Japan
| | - Masahito Ohji
- Department of Ophthalmology, Shiga University of Medical Science, Otsu, Shiga, Japan
| | | | - Tobias Machewitz
- Department of Research and Development, Bayer AG, Berlin, Germany
| | - Koji Sasaki
- Department of Medical Affairs and Pharmacovigilance, Bayer Yakuhin Ltd., Osaka, Japan
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Visual acuity outcomes of anti-VEGF treatment for neovascular age-related macular degeneration in clinical trials. Jpn J Ophthalmol 2021; 65:741-760. [PMID: 34491474 DOI: 10.1007/s10384-021-00869-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 07/05/2021] [Indexed: 12/26/2022]
Abstract
Anti-VEGF treatment for neovascular age-related macular degeneration (nAMD) has been evaluated in clinical trials. To select the best anti-VEGF drug and the best treatment regimen for nAMD, a thorough understanding of the characteristics of each anti-VEGF drug and treatment regimen is essential. In this review, we summarized visual acuity (VA) changes in 30 previous clinical trials of anti-VEGF treatment for nAMD. In most studies, ranibizumab, aflibercept, and brolucizumab improved the VA by 6 to 12 letters from the baseline VA of 50-65 letters and maintained the VA improvement regardless of the treatment regimen; the VA improved from 0.2-0.4 to 0.3-0.7 in Snellen equivalents. The improvement was rapid during the first month and became slower after the second injection, and 60% to 90% of the VA improvement was attained within the first 3 months. The upper limit of the VA improvement should be determined according to eyes with nAMD themselves, not according to anti-VEGF drugs or treatment regimens. Since a fixed regimen can result in overtreatment, whilst a pro re nata regimen can result in insufficient treatment, a treat-and-extend regimen would be optimal to treat nAMD. Insufficient treatment fails to improve VA to the upper limit and/or to maintain the improved VA, whereas overtreatment can cause macular atrophy. One study reported no difference in the risk of macular atrophy between ranibizumab and aflibercept, whilst many studies have suggested that aflibercept causes more choroidal thinning, one of the risk factors for macular atrophy, than does ranibizumab. Further evaluation of drugs and regimens should be performed from the viewpoint of complications and minimum number of injections required to improve and maintain VA.
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Silva R, Arias L, Nunes S, Farinha C, Coimbra R, Marques JP, Cachulo ML, Figueira J, Barreto P, Madeira MH, Pires I, Sousa JC, Distefano L, Rosa P, Carneiro Â, Vaz-Pereira S, Meireles A, Cabrera F, Bures A, Mendonça L, Fernandez-Vega-Sanz A, Barrão S, Koh A, Cheung CMG, Cunha-Vaz JG, Murta J. Efficacy and safety of Intravitreal Aflibercept Vs Verteporfin Photodynamic Therapy in a Caucasian Population with Polypoidal Choroidal Vasculopathy: A Randomized Clinical Trial. Ophthalmologica 2021; 245:80-90. [PMID: 34348351 DOI: 10.1159/000518235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 07/02/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Rufino Silva
- Association of Innovation and Biomedical Research in Light and Image (AIBILI), Coimbra, Portugal
- Ophthalmology Department, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Espaço Médico de Coimbra, Coimbra, Portugal
| | - Luis Arias
- Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Sandrina Nunes
- Association of Innovation and Biomedical Research in Light and Image (AIBILI), Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Claudia Farinha
- Association of Innovation and Biomedical Research in Light and Image (AIBILI), Coimbra, Portugal
- Ophthalmology Department, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal
| | - Rita Coimbra
- Association of Innovation and Biomedical Research in Light and Image (AIBILI), Coimbra, Portugal
| | - João P Marques
- Association of Innovation and Biomedical Research in Light and Image (AIBILI), Coimbra, Portugal
- Ophthalmology Department, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal
| | - Maria L Cachulo
- Association of Innovation and Biomedical Research in Light and Image (AIBILI), Coimbra, Portugal
- Ophthalmology Department, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - João Figueira
- Association of Innovation and Biomedical Research in Light and Image (AIBILI), Coimbra, Portugal
- Ophthalmology Department, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Espaço Médico de Coimbra, Coimbra, Portugal
| | - Patricia Barreto
- Association of Innovation and Biomedical Research in Light and Image (AIBILI), Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Department of Orthoptics, School of Health, Polytechnic of Porto, Oporto, Portugal
| | - Maria H Madeira
- Association of Innovation and Biomedical Research in Light and Image (AIBILI), Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Isabel Pires
- Association of Innovation and Biomedical Research in Light and Image (AIBILI), Coimbra, Portugal
- Ophthalmology Department, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal
| | | | | | - Paulo Rosa
- Instituto Retina Diabetes Ocular de Lisboa, Lisbon, Portugal
| | - Ângela Carneiro
- Department of Ophthalmology, Centro Hospitalar de São João, EPE, Oporto, Portugal
| | - Sara Vaz-Pereira
- Department of Ophthalmology, Centro Hospitalar Universitário de Lisboa Norte, EPE - Hospital de Santa Maria, Lisbon, Portugal
- Department of Ophthalmology, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | | | | | | | - Luís Mendonça
- Department of Ophthalmology, Hospital Braga, Braga, Portugal
| | | | - Sandra Barrão
- Instituto de Oftalmologia Dr. Gama Pinto, Lisbon, Portugal
| | - Adrian Koh
- Eye & Retina Surgeons, Singapore, Singapore
| | | | - José G Cunha-Vaz
- Association of Innovation and Biomedical Research in Light and Image (AIBILI), Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Espaço Médico de Coimbra, Coimbra, Portugal
| | - Joaquim Murta
- Association of Innovation and Biomedical Research in Light and Image (AIBILI), Coimbra, Portugal
- Ophthalmology Department, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal
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Timing of Complete Polypoidal Regression after Intravitreous Aflibercept Treatments in Polypoidal Choroidal Vasculopathy. Ophthalmol Retina 2021; 6:21-28. [PMID: 33781929 DOI: 10.1016/j.oret.2021.03.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 02/19/2021] [Accepted: 03/23/2021] [Indexed: 11/22/2022]
Abstract
PURPOSE To understand timing of complete polypoidal regression on indocyanine green angiography (ICGA) after aflibercept injections for polypoidal choroidal vasculopathy (PCV). DESIGN Multicenter prospective study. PARTICIPANTS Adults with treatment-naïve PCV. METHODS After institutional review board approval, participants were enrolled and followed up for 1 year, from Apr 1, 2016, through Dec 30, 2018, at 2 university-based centers in Thailand. Diagnosis of PCV was based on the Efficacy and Safety of Verteporfin Photodynamic Therapy in Combination with Ranibizumab or Alone versus Ranibizumab Monotherapy in Patients with Symptomatic Macular Polypoidal Choroidal Vasculopathy criteria. Eligible eyes received fixed-dose aflibercept injections (3 monthly then every 8 weeks), or monthly if fluid persisted on OCT. Photodynamic therapy (PDT) was administered when fluid persisted despite 6 consecutive injections. Indocyanine green angiography was performed at baseline and then every 8 weeks. The 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) was administered at baseline, 6 months, and 1 year. Two retina specialists reviewed posttreatment ICGA, categorized into: complete regression (complete disappearance of polypoidal lesions), partial regression (reduced in size or number), or no regression. Disagreements were resolved through open adjudication. MAIN OUTCOME MEASURES Timing of complete regression over 1 year. RESULTS Final analysis included 40 eyes (39 participants; 100% Thai, 59% women; mean age±standard deviation, 64 ± 8.3 years). At baseline, 90% had 5 or more polypoidal lesions. Ninety-five percent received aflibercept monotherapy, and 5% received rescue PDT per protocol. Polypoidal statuses at 1 year were 55% complete, 40% partial, and 5% no regression. Cumulative rates of complete regression at 2, 4, 6, and 12 months were 28%, 33%, 43%, and 55%. Of 22 eyes with complete regression at 1 year, complete regression was identified first at 2, 4, 6, 8, 10, 12 months in 50%, 9%, 18%, 5%, 9%, and 9%, respectively. Cumulative rates of complete regression among these eyes at 2, 6, and 12 months were 50%, 77%, and 100%, respectively. Median duration of complete regression was 3 months (interquartile range, 2-6 months). Median visual acuity improved from 20/125 (Snellen equivalent) to 20/50; median NEI VFQ-25 scores improved from 80 to 93 from baseline to 1 year. CONCLUSIONS Complete polypoidal regression could occur as early as 2 months after aflibercept injections. Most PCV eyes with complete polypoidal regression at 1 year already showed complete regression within the first 6 months. These findings support consideration of aflibercept for PCV to achieve both anatomic and visual outcomes.
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Choo HG, Lee JH, Oh HS, Kim SH, You YS, Kwon OW. One-year outcomes of fixed-dosing Aflibercept therapy for pre treated and naive polypoidal choroidal vasculopathy patient. BMC Ophthalmol 2021; 21:94. [PMID: 33602156 PMCID: PMC7890830 DOI: 10.1186/s12886-021-01829-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 01/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Polypoidal choroidal vasculopathy (PCV) is a type of age-related macular degeneration that can cause permanent vision loss. The purpose of this paper was to report the one-year outcomes of fixed-dosing aflibercept therapy for the treatment of PCV. METHODS This was a prospective, single-arm, interventional case series study of 25 PCV patients; 12 pre-treated and 13 treatment-naïve patients. The patients were treated and monitored for 12 months. Each patient was administered with an aflibercept (2.0 mg) injection every month for the first 3 months (the loading phase), and thereafter, once every 2 months. At every follow-up visit, best-corrected visual acuity (BCVA) test, fundus examination, and optical coherence tomography for measuring the central subfield macular thickness (CSMT) were performed. Fluorescein and indocyanine green angiography were conducted at baseline and at 4 and 12 months. RESULTS After 12 months of aflibercept therapy, the mean BCVA of the patients significantly improved from 65.48 letters at baseline to 69.91 letters (p=0.001), and the CSMT significantly decreased from 406.92 um at baseline to 276.12 um (p< 0.001). Additionally, ten patients (40%) showed complete polyp regression. The treatment-naïve patients showed a statistically significant improvement in BCVA from 66.58 letters at baseline to 76.36 letters at 12 months, and a significant decrease in CSMT, from 462 to 243 um. In the pre-treated group, there was no change in BCVA (64.46 letters), and the decrease in CSMT from 356.08 to 303.69 um was not statistically significant. CONCLUSIONS The fixed-dosing aflibercept regimen is effective for treating patients with PCV and is more effective in treatment-naïve patients than in pre-treated patients. TRIAL REGISTRATION Clinical Research Information Service (CRiS), Republic of Korea. Identifer: KCT0005798, Registered: Jan 20, 2021. Retrospectively registered, URL: https://cris.nih.go.kr/cris/en/search/search_result_st01.jsp?seq=18546.
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Affiliation(s)
- Hun Gu Choo
- Department of Ophthalmology, Wonju College of Medicine - Yonsei University, Wonju, Republic of Korea
| | - Jin Hae Lee
- Department of Ophthalmology, First St. Marys Eye Clinic, Seoul, Republic of Korea
| | - Hyun Sub Oh
- Department of Ophthalmology, Nune Eye Hospital, Noon Bldg 404, Seonreung-ro Gangnam-gu, 06198, Seoul, Republic of Korea
| | - Soon Hyun Kim
- Department of Ophthalmology, Nune Eye Hospital, Noon Bldg 404, Seonreung-ro Gangnam-gu, 06198, Seoul, Republic of Korea
| | - Yong Sung You
- Department of Ophthalmology, Nune Eye Hospital, Noon Bldg 404, Seonreung-ro Gangnam-gu, 06198, Seoul, Republic of Korea
| | - Oh Woong Kwon
- Department of Ophthalmology, Nune Eye Hospital, Noon Bldg 404, Seonreung-ro Gangnam-gu, 06198, Seoul, Republic of Korea.
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Ogura Y, Iida T, Lee WK, Cheung CMG, Mitchell P, Leal S, Schmelter T, Ishibashi T. Efficacy and safety of intravitreal aflibercept for polypoidal choroidal vasculopathy: 96-week outcomes in the Japanese subgroup of the PLANET study. Jpn J Ophthalmol 2021; 65:344-353. [PMID: 33474611 DOI: 10.1007/s10384-020-00805-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 10/31/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE To evaluate the efficacy and safety of intravitreal aflibercept (IVT-AFL) versus IVT-AFL plus rescue photodynamic therapy (IVT-AFL + rPDT) in the subgroup of Japanese patients with polypoidal choroidal vasculopathy (PCV) enrolled in the PLANET study. STUDY DESIGN A 96-week, double-masked, sham-controlled phase-3b/4 randomized clinical trial conducted at multiple centers from May 2014 to August 2016. PATIENTS AND METHODS Patients with PCV (BCVA 73-24 ETDRS letters [20/40-20/320 Snellen]) received 3 initial monthly doses of IVT-AFL 2 mg. At week 12, the patients were randomly assigned 1:1 to IVT-AFL + sham PDT or IVT-AFL + rPDT. Patients not requiring rescue received IVT-AFL every 8 weeks; those requiring rescue received IVT-AFL monthly plus sham/active PDT. Following week 52, the treatment intervals could be extended > 8 weeks. RESULTS The baseline demographics for the 159 Japanese patients were balanced. At week 96, the mean BCVA change was + 9.7 (IVT-AFL) versus + 9.5 letters (IVT-AFL + rPDT) (least-squares mean difference of - 0.3; 95% CI, - 3.7 to 3.1); the mean central subfield thickness reduction was - 148.0 µm versus - 145.9 µm. Overall, 17.1% of the patients required rescue PDT. At week 96, 25.0% (IVT-AFL) and 37.9% (IVT-AFL + rPDT) of the patients had complete polyp regression; 84.1% (IVT-AFL) and 88.4% (IVT-AFL + rPDT) of the patients had no evidence of active polyps. The mean number of injections (weeks 52-96) were 4.6 (IVT-AFL) and 4.5 (IVT-AFL + rPDT). Overall, 36.0% (IVT-AFL) and 33.8% (IVT-AFL + rPDT) of the patients experienced ocular treatment-emergent adverse events. CONCLUSION IVT-AFL monotherapy was efficacious for the treatment of Japanese patients with PCV, and the addition of rescue PDT did not show additional benefits.
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Affiliation(s)
- Yuichiro Ogura
- Department of Ophthalmology and Visual Science, Nagoya City University Graduate School of Medical Sciences, Nagoya, 467-8601, Japan.
| | - Tomohiro Iida
- Department of Ophthalmology, Tokyo Women's Medical University, Tokyo, Japan
| | | | - Chui Ming Gemmy Cheung
- Singapore National Eye Centre and Singapore Eye Research Institute, Singapore, Singapore.,Duke-NUS, National University of Singapore, Singapore, Singapore
| | - Paul Mitchell
- University of Sydney, Westmead Institute for Medical Research, Sydney, Australia
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REDUCED VASCULAR DENSITY IN THE CHOROID AFTER TREATMENT WITH PHOTODYNAMIC THERAPY COMBINED WITH AFLIBERCEPT IN PATIENTS WITH POLYPOIDAL CHOROIDAL VASCULOPATHY. Retina 2021; 41:156-161. [PMID: 32251239 DOI: 10.1097/iae.0000000000002793] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate changes of vascular density in the choroid of patients with polypoidal choroidal vasculopathy treated with photodynamic therapy (PDT) combined with intravitreal aflibercept. METHODS This study examined 12 eyes of 12 patients, who were diagnosed as polypoidal choroidal vasculopathy. All patents underwent optical coherence tomography before and at 3 months after PDT combined with intravitreal aflibercept treatment. Using en face optical coherence tomography images, we analyzed vascular density of the area outside the polypoidal choroidal vasculopathy lesion and within the PDT exposure area at the level of the choriocapillaris and middle layer of the choroid. In the outer layer of the choroid, the thickest vessel was selected in the area exposed to PDT, with the diameter of the vessel analyzed. RESULTS The vascular density in the choriocapillaris and middle layer of the choroid significantly decreased from 0.54 ± 0.09 before treatment to 0.44 ± 0.07 after PDT treatment in the choriocapillaris and from 0.53 ± 0.10 to 0.47 ± 0.08 in the middle layer of the choroid, respectively. There was also a significant reduction in the diameter of the largest vessel from 309 ± 85 µm at baseline to 220 ± 52 µm. CONCLUSION Photodynamic therapy may cause occlusion of the choriocapillaris and middle vessels in the choroid, as well as stenosis of the large vessels.
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Ye LH, Cai Y, Shi X, Wong IYH, Qu JF, Zhao MW, Ying X, Li XX. One-year results of intravitreal conbercept in treatment-naïve subjects with polypoidal choroidal vasculopathy. Graefes Arch Clin Exp Ophthalmol 2020; 259:1455-1462. [PMID: 33146832 DOI: 10.1007/s00417-020-04988-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 10/14/2020] [Accepted: 10/20/2020] [Indexed: 02/05/2023] Open
Abstract
PURPOSE To evaluate the functional and structural outcomes of intravitreal conbercept monotherapy using a "3 + pro re nata (PRN)" regimen in treatment-naïve subjects with polypoidal choroidal vasculopathy (PCV) up to 12 months. METHODS Thirty subjects (30 eyes) with PCV participated in this interventional, retrospective study. All subjects received intravitreal injections of 0.5 mg (0.05 ml) conbercept using a "3 + PRN" regimen for 12 months. The changes in best-corrected visual acuity (BCVA) and optical coherence tomography (OCT) parameters, polyp lesion area, and regression rate were evaluated at baseline, month 3, and month 12. RESULTS At the study end-point, BCVA improved significantly from 52.80 ± 17.17 ETDRS letters at baseline to 62.20 ± 18.96 letters (P < 0.001), with a mean gain of 9.40 ± 14.97 letters. The central retinal thickness (CRT) significantly reduced from 454.93 ± 147.31 μm at baseline to 308.73 ± 106.80 μm (P < 0.001) at end-point, and the total macular volume (TMV) decreased from 9.51 ± 1.04 mm3 at baseline to 8.32 ± 0.84 mm3 at end-point (P < 0.001). The mean volume of pigment epithelial detachment (PED) decreased from 0.73 ± 0.97 mm3 at baseline to 0.48 ± 0.71 mm3 (P < 0.05) at month 3. At month 12, the mean volume of PED was 0.57 ± 0.80 mm3 (P > 0.05 compared to baseline). After the 3-monthly loading injections, 6 eyes (20.0%) showed complete polyp regression, whereas a total of 19 eyes (63.5%) showed complete regression at month 12. The average injections given per subject were 7.70 ± 1.81. CONCLUSION Intravitreal conbercept using the "3 + PRN" regimen was effective in the treatment of PCV.
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Affiliation(s)
- Lin-Hong Ye
- Department of Ophthalmology, Peking University People's Hospital, Beijing, China.,Eye Diseases and Optometry Institute, Beijing, China.,Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China.,College of Optometry, Peking University Health Science Center, Beijing, China
| | - Yi Cai
- Department of Ophthalmology, Peking University People's Hospital, Beijing, China.,Eye Diseases and Optometry Institute, Beijing, China.,Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China.,College of Optometry, Peking University Health Science Center, Beijing, China
| | - Xuan Shi
- Department of Ophthalmology, Peking University People's Hospital, Beijing, China.,Eye Diseases and Optometry Institute, Beijing, China.,Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China.,College of Optometry, Peking University Health Science Center, Beijing, China
| | - Ian Yat Hin Wong
- Department of Ophthalmology, The Hong Kong Sanatorium and Hospital, Happy Valley, Hong Kong SAR, China
| | - Jin-Feng Qu
- Department of Ophthalmology, Peking University People's Hospital, Beijing, China.,Eye Diseases and Optometry Institute, Beijing, China.,Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China.,College of Optometry, Peking University Health Science Center, Beijing, China
| | - Ming-Wei Zhao
- Department of Ophthalmology, Peking University People's Hospital, Beijing, China.,Eye Diseases and Optometry Institute, Beijing, China.,Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China.,College of Optometry, Peking University Health Science Center, Beijing, China
| | - Xin Ying
- Department of Ophthalmology, Peking University People's Hospital, Beijing, China.,Eye Diseases and Optometry Institute, Beijing, China.,Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China.,College of Optometry, Peking University Health Science Center, Beijing, China
| | - Xiao-Xin Li
- Department of Ophthalmology, Peking University People's Hospital, Beijing, China. .,Eye Diseases and Optometry Institute, Beijing, China. .,Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China. .,College of Optometry, Peking University Health Science Center, Beijing, China. .,Xiamen Eye Center of Xiamen University, Xiamen, Fujian Province, China.
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Abstract
PURPOSE To compare the 6-month efficacy of the intravitreal injection of conbercept or ranibizumab for patients with polypoidal choroidal vasculopathy (PCV). METHODS This is a retrospective case-control study involved 79 PCV eyes of 77 patients. The PCV eyes were treated with an intravitreal injection of either ranibizumab (n = 44) or conbercept (n = 35). Three monthly loading doses were injected and followed by retreatment as needed. The best-corrected visual acuity and angiographic characteristics were evaluated after 6 months. RESULTS The mean logarithm of the minimum angle of resolution best-corrected visual acuity had improved from 0.86 (Snellen equivalent, 20/145) at baseline to 0.70 (Snellen equivalent, 20/100) at 6 months in the conbercept group (P < 0.001), and from 0.74 (Snellen equivalent, 20/110) at baseline to 0.63 (Snellen equivalent, 20/85) at 6 months in the ranibizumab group (P = 0.032), respectively. The central foveal thickness was decreased from 407 ± 146 μm to 230 ± 71 μm in the conbercept group (P < 0.001), and from 394 ± 93 μm to 208 ± 56 μm in the ranibizumab group (P < 0.001). Polyps were completely regressed and in 21 (47.7%) eyes in the conbercept group at 6 months, significant higher than in 10 (28.6%) eyes in the ranibizumab group (P = 0.029). CONCLUSION Both conbercept and ranibizumab effectively increased the visual acuity and regressed the polyps of PCV eyes. No significant difference was found in the visual acuity improvement of the patients with PCV between the conbercept group and ranibizumab group at 6 months. However, conbercept was superior to ranibizumab monotherapy in the regression of polyps.
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10
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Intravitreal aflibercept for submacular hemorrhage secondary to neovascular age-related macular degeneration and polypoidal choroidal vasculopathy. Graefes Arch Clin Exp Ophthalmol 2019; 258:107-116. [DOI: 10.1007/s00417-019-04474-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 08/21/2019] [Accepted: 09/07/2019] [Indexed: 12/13/2022] Open
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Lee WK, Iida T, Ogura Y, Chen SJ, Wong TY, Mitchell P, Cheung GCM, Zhang Z, Leal S, Ishibashi T. Efficacy and Safety of Intravitreal Aflibercept for Polypoidal Choroidal Vasculopathy in the PLANET Study: A Randomized Clinical Trial. JAMA Ophthalmol 2019; 136:786-793. [PMID: 29801063 DOI: 10.1001/jamaophthalmol.2018.1804] [Citation(s) in RCA: 164] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Importance Polypoidal choroidal vasculopathy (PCV) is common in Asian populations, but an optimal treatment approach remains to be confirmed. Objective To evaluate intravitreal aflibercept injection (IAI) in participants with PCV and compare IAI monotherapy with IAI plus rescue photodynamic therapy (PDT). Design, Setting, and Participants This 96-week, double-masked, sham-controlled phase 3b/4 randomized clinical trial was conducted at multiple centers in Australia, Germany, Hong Kong, Hungary, Japan, Singapore, South Korea, and Taiwan from May 2014 to August 2016, and included adults 50 years or older with symptomatic macular PCV and a best-corrected visual acuity of 73 to 24 Early Treatment Diabetic Retinopathy Study letters (20/40-20/320 Snellen equivalent). Interventions Participants received 2 mg of IAI at weeks 0, 4, and 8. At week 12, participants with a suboptimal response were randomized 1:1 to receive IAI plus sham PDT (IAI monotherapy) or a "rescue" of IAI plus rescue PDT (IAI/PDT). Participants who did not qualify for rescue received IAI every 8 weeks; those qualifying for rescue received IAI every 4 weeks plus sham/active PDT. When the rescue criteria were no longer met, injection intervals were gradually extended to 8 weeks. Main Outcomes and Measures Noninferiority of IAI monotherapy to IAI/PDT for mean change in best-corrected visual acuity from baseline to week 52 (95% CI of the difference entirely above -5 letters). Results Of the 318 participants, the mean (SD) age was 70.6 (8.2) years, 96 (30.2%) were women, and 152 (47.8%) were Japanese. Monotherapy with IAI was noninferior to IAI/PDT for the primary end point (+10.7 vs +10.8 letters, respectively; 95% CI, -2.9 to 1.6; P = .55), with few participants requiring rescue therapy (19 [12.1%] vs 23 [14.3%], respectively). Participants in both treatment groups had similar reductions in central subfield thickness from baseline to week 52 (-137.7 [IAI monotherapy] vs -143.5 μm [IAI/PDT]). At week 52, 49 (38.9%) and 60 participants (44.8%) had no polypoidal lesions observed on indocyanine green angiography in the IAI monotherapy and IAI/PDT groups, respectively. Furthermore, 116 (81.7%) and 136 (88.9%), respectively, had no polypoidal lesions with leakage. The most frequent ocular adverse events were conjunctival hemorrhage (IAI monotherapy, 8 [5.1%]) and dry eye (IAI/PDT, 9 [5.6%]). Conclusions and Relevance Improvement in visual and/or functional outcomes was achieved in more than 85% of participants who were treated with IAI monotherapy, with no signs of leakage from polypoidal lesions in more than 80%. As fewer than 15% met the criteria of a suboptimal response to receive PDT, the potential benefit of adding PDT cannot be determined. Trial Registration ClinicalTrials.gov Identifier: NCT02120950.
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Affiliation(s)
- Won Ki Lee
- Department of Ophthalmology, Seoul St Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Tomohiro Iida
- Department of Ophthalmology, Tokyo Women's Medical University, Tokyo, Japan
| | - Yuichiro Ogura
- Department of Ophthalmology and Visual Science, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Shih-Jen Chen
- Department of Ophthalmology, Taipei Veterans General Hospital, School of Medicine, National Yang-Ming University Taipei, Taiwan
| | - Tien Yin Wong
- Singapore Eye Research Institute and National Eye Centre, Singapore.,Duke-NUS Medical School, National University of Singapore, Singapore
| | - Paul Mitchell
- University of Sydney, Sydney, Australia (Westmead Institute for Medical Research)
| | - Gemmy Chui Ming Cheung
- Singapore Eye Research Institute and National Eye Centre, Singapore.,Duke-NUS Medical School, National University of Singapore, Singapore
| | | | | | - Tatsuro Ishibashi
- Department of Ophthalmology, Kyushu University Hospital, Fukuoka, Japan
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Talks J, Daien V, Finger RP, Eldem B, Sakamoto T, Cardillo JA, Mitchell P, Wong TY, Korobelnik JF. The use of real-world evidence for evaluating anti–vascular endothelial growth factor treatment of neovascular age-related macular degeneration. Surv Ophthalmol 2019; 64:707-719. [DOI: 10.1016/j.survophthal.2019.02.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 02/12/2019] [Accepted: 02/13/2019] [Indexed: 12/15/2022]
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Wong TY, Ogura Y, Lee WK, Iida T, Chen SJ, Mitchell P, Gemmy Cheung CM, Zhang Z, Leal S, Ishibashi T. Efficacy and Safety of Intravitreal Aflibercept for Polypoidal Choroidal Vasculopathy: Two-Year Results of the Aflibercept in Polypoidal Choroidal Vasculopathy Study. Am J Ophthalmol 2019; 204:80-89. [PMID: 30849345 DOI: 10.1016/j.ajo.2019.02.027] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 02/21/2019] [Accepted: 02/22/2019] [Indexed: 01/03/2023]
Abstract
PURPOSE We sought to evaluate longer-term efficacy and safety of intravitreal aflibercept monotherapy (IAI) vs IAI plus rescue photodynamic therapy (rPDT) in patients with polypoidal choroidal vasculopathy (PCV). DESIGN This was a prospective multicenter, double-masked, sham-controlled randomized clinical study across 62 centers. METHODS In this phase 3b/4 study, patients with PCV with best-corrected visual acuity of 73-24 Early Treatment Diabetic Retinopathy Study letters (20/40-20/320 Snellen equivalent) received IAI 2 mg every 4 weeks until week 12, when they were randomized 1:1 to receive IAI or IAI plus rPDT if rescue criteria were met. Patients not requiring rescue received IAI every 8 weeks; those requiring rescue received IAI every 4 weeks plus sham/active PDT. At week 52 (the primary endpoint), IAI was noninferior to IAI plus rPDT. After week 52, treatment intervals could be extended beyond 8 weeks at the investigators' discretion. Noninferiority of IAI vs IAI plus rPDT for mean best-corrected visual acuity change from baseline to week 96 was evaluated. RESULTS Over 96 weeks, 54 patients (17.0%) met rescue criteria. At week 96, IAI was noninferior to IAI plus rPDT in terms of Early Treatment Diabetic Retinopathy Study letters gained (+10.7 vs +9.1, P = .48). Proportions of patients with complete polyp regression (33.1% vs 29.1%) or without active polyps (82.1% vs 85.6%) were similar. In year 2, the mean number of injections was 4.6 in both arms. No new safety signals were observed. CONCLUSION IAI monotherapy was noninferior to IAI with rescue PDT up to 96 weeks, and functional and anatomical improvements achieved at 52 weeks were maintained. Few patients required rescue PDT, which provided no additional visual benefit.
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Affiliation(s)
- Tien Yin Wong
- Singapore Eye Research Institute and Singapore National Eye Centre, Singapore; Duke-National University of Singapore Medical School, National University of Singapore, Singapore.
| | - Yuichiro Ogura
- Department of Ophthalmology and Visual Science, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Won Ki Lee
- Department of Ophthalmology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Tomohiro Iida
- Department of Ophthalmology, Tokyo Women's Medical University, Tokyo, Japan
| | - Shih-Jen Chen
- Department of Ophthalmology, Taipei Veterans General Hospital and School of Medicine, National Yang-Ming University Taipei, Taiwan
| | - Paul Mitchell
- University of Sydney, Sydney, New South Wales, Australia (Westmead Institute for Medical Research)
| | - Chui Ming Gemmy Cheung
- Singapore Eye Research Institute and Singapore National Eye Centre, Singapore; Duke-National University of Singapore Medical School, National University of Singapore, Singapore
| | | | | | - Tatsuro Ishibashi
- Department of Ophthalmology, Kyushu University Hospital, Fukuoka, Japan
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Seong S, Choo HG, Kim YJ, Kim JY, Lee JH, Oh HS, You YS, Kim SH, Kwon OW. Novel Findings of Polypoidal Choroidal Vasculopathy via Optical Coherence Tomography Angiography. KOREAN JOURNAL OF OPHTHALMOLOGY 2019; 33:54-62. [PMID: 30746912 PMCID: PMC6372389 DOI: 10.3341/kjo.2018.0048] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 08/08/2018] [Indexed: 01/17/2023] Open
Abstract
Purpose To introduce novel findings of polypoidal choroidal vasculopathy (PCV) via optical coherence tomography angiography (OCTA) Methods This study is a retrospective chart review of 16 patients (16 eyes) with PCV. OCTA (Avanti RTVue XR) findings were evaluated and selected for analysis after agreement by two retina specialists . Results Twenty one polyps in 16 eyes (16 patients) with PCV were included in this study. The mean patient age was 67 years (13 men and three women). The shape of polypoidal lesions on OCTA at initial were halo (five polyps), rosette (seven polyps), and vascular network (nine polyps). Eight months after anti-vascular endothelial growth factor treatment, in a total of four eyes, seven polyps could be followed up completely, the two halo type polypoidal lesions changed to rosette and vascular network type. The lesions of three rosette and two vascular network type lesions did not change in shape. In addition, the size of the polypoidal lesions (one among two halo types, two among three rosette types, and two among two vascular network types) decreased, but one halo type did not change and one rosette type increased in size on OCTA. Conclusions En-face OCTA enabled us to categorize novel types of PCV with polypoidal lesions.
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Affiliation(s)
- San Seong
- Department of Ophthalmology, Nune Eye Hospital, Seoul, Korea
| | - Hun Goo Choo
- Department of Ophthalmology, Nune Eye Hospital, Seoul, Korea
| | - Yang Jae Kim
- Department of Ophthalmology, Nune Eye Hospital, Seoul, Korea
| | - Ju Young Kim
- Department of Ophthalmology, Nune Eye Hospital, Seoul, Korea
| | - Jin Hae Lee
- Department of Ophthalmology, Nune Eye Hospital, Seoul, Korea
| | - Hyun Sup Oh
- Department of Ophthalmology, Nune Eye Hospital, Seoul, Korea
| | - Yong Sung You
- Department of Ophthalmology, Nune Eye Hospital, Seoul, Korea
| | - Soon Hyun Kim
- Department of Ophthalmology, Nune Eye Hospital, Seoul, Korea
| | - Oh Woong Kwon
- Department of Ophthalmology, Nune Eye Hospital, Seoul, Korea.
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Wang L, Zhang C, Hua R. Clinical effectiveness of ranibizumab and conbercept for neovascular age-related macular degeneration: a meta-analysis. DRUG DESIGN DEVELOPMENT AND THERAPY 2018; 12:3625-3633. [PMID: 30464394 PMCID: PMC6211581 DOI: 10.2147/dddt.s176021] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Introduction To assess the ocular efficacy of intravitreal ranibizumab and conbercept injection in patients with neovascular age-related macular degeneration. Materials and methods We searched PubMed, Wed of Science, Cochrane Library, EMBASE, Google Scholar, Medline, China National Knowledge Infrastructure, and WANFANG DATA databases, up to June 20, 2018. We also searched abstracts and clinical study presentations at meetings as well as trial registries; we contacted authors of included studies if questions arose. Eligibility criteria for selection of studies were randomized controlled trials and retrospective trials that compared ranibizumab with conbercept for treatment of neovascular age-related macular degeneration. Results Eight randomized controlled trials and four retrospective studies were included with a total of 853 patients. Best-corrected visual acuity after loading dosage was improved in the conbercept group, compared with the ranibizumab group (weighted mean difference: -0.04; 95% CI: -0.07 to 0.00; P=0.04). There was a significant difference between conbercept and ranibizumab therapy with respect to unchanged or recurrent leakage of choroidal neovascularization (OR: 0.46; 95% CI: 0.24-0.88; P=0.02). No significant differences were observed in central macular thickness (weighted mean difference: -2.92; 95% CI: -9.00 to 3.17; P=0.35), complete and partial closure of leakage of choroidal neovascularization (complete closure, P=0.70; partial closure, P=0.35), or number of injections (weighted mean difference: 0.42; 95% CI: -0.46 to 1.29; P=0.35) between the conbercept and ranibizumab groups at the end of the follow-up periods. Conclusion Pooled evidence confirmed that conbercept was superior to ranibizumab with respect to visual gain after treatment. Additional studies with long-term follow-up are needed to support our conclusion.
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Affiliation(s)
- Luping Wang
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Canwei Zhang
- Department of Ophthalmology, Weifang Eye Hospital, Weifang, People's Republic of China
| | - Rui Hua
- Department of Ophthalmology, First Hospital of China Medical University, Shenyang, People's Republic of China,
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COMPARISON OF OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHIC CHANGES AFTER ANTI–VASCULAR ENDOTHELIAL GROWTH FACTOR THERAPY ALONE OR IN COMBINATION WITH PHOTODYNAMIC THERAPY IN POLYPOIDAL CHOROIDAL VASCULOPATHY. Retina 2018; 38:1675-1687. [DOI: 10.1097/iae.0000000000001776] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Anantharaman G, Sheth J, Bhende M, Narayanan R, Natarajan S, Rajendran A, Manayath G, Sen P, Biswas R, Banker A, Gupta C. Polypoidal choroidal vasculopathy: Pearls in diagnosis and management. Indian J Ophthalmol 2018; 66:896-908. [PMID: 29941728 PMCID: PMC6032720 DOI: 10.4103/ijo.ijo_1136_17] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Polypoidal choroidal vasculopathy (PCV) is increasingly recognized as an important cause of exudative maculopathy in Asians as against Wet age-related macular degeneration in Caucasians. A panel of retinal experts methodically evaluated pertinent updated literature on PCV with thorough PubMed/MEDLINE search. Based on this, the panel agreed upon and proposed the current consensus recommendations in the diagnosis (clinical and imaging), management and follow-up schedule of PCV. Diagnosis of PCV should be based on the gold standard indocyanine green angiography which demonstrates early nodular hyperfluorescence signifying the polyp with additional features such as abnormal vascular network (AVN). Optical coherence tomography is an excellent adjuvant for diagnosing PCV, monitoring disease activity, and decision-making regarding the treatment. Current treatment modalities for PCV include photodynamic therapy, anti-vascular endothelial growth factor agents, and thermal laser. Choice of specific treatment modality and prognosis depends on multiple factors such as the location and size of PCV lesion, presence or absence of polyp with residual AVN, amount of submacular hemorrhage, presence or absence of leakage on fundus fluorescein angiography, visual acuity, and so on. Current recommendations would be invaluable for the treating physician in diagnosing PCV and in formulating the best possible individualized treatment strategy for optimal outcomes in PCV management.
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Affiliation(s)
| | - Jay Sheth
- Department of Vitreoretina, Giridhar Eye Institute, Kochi, Kerala, India
| | - Muna Bhende
- Department of Vitreoretinal Services, Sri Bhagwan Mahavir Vitreoretinal Services, Medical Research Foundation, Chennai, Tamil Nadu, India
| | - Raja Narayanan
- Smt. Kanuri Santhamma Centre for Vitreo Retinal Diseases, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Sundaram Natarajan
- Department of Vitreoretina, Aditya Jyot Eye Hospital Pvt. Ltd., Mumbai, Maharashtra, India
| | - Anand Rajendran
- Retina-Vitreous Service, Aravind Eye Hospital, Postgraduate Institute of Ophthalmology, Madurai, Tamil Nadu, India
| | - George Manayath
- Department of Retina and Ocular Oncology, Aravind Eye Hospital, Coimbatore, Tamil Nadu, India
| | - Parveen Sen
- Department of Vitreoretinal Services, Sri Bhagwan Mahavir Vitreoretinal Services, Medical Research Foundation, Chennai, Tamil Nadu, India
| | - Rupak Biswas
- Department of Vitreoretina, B. B. Eye Foundation, Kolkata, West Bengal, India
| | - Alay Banker
- Bankers Retina Clinic and Laser Centre, Ahmedabad, Gujarat, India
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Medina-Baena M, Huertos-Carrillo MJ, Rodríguez L, García-Pulido JI, Cornejo-Castillo C, Calandria-Amiguetti JM. One-Year Outcome of Aflibercept and Photodynamic Therapy in a Caucasian Patient with Polypoidal Choroidal Vasculopathy Refractory to Ranibizumab and Photodynamic Therapy. Case Rep Ophthalmol 2018; 9:172-178. [PMID: 29681832 PMCID: PMC5903101 DOI: 10.1159/000487227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 01/25/2018] [Indexed: 11/19/2022] Open
Abstract
Polypoidal choroidal vasculopathy (PCV) is a subtype of neovascular age-related macular degeneration characterised by an abnormal branching vascular network with aneurysmal polypoidal choroidal vascular lesions. PCV is more prevalent in Asian populations than in Caucasians, which may explain its underdiagnosis in Western countries. Evidence regarding the efficacy of different anti-vascular endothelial growth factor (anti-VEGF) agents on PCV is scarce, with most of these studies being conducted in Asian treatment-naïve patients. Ranibizumab was the first anti-VEGF agent to demonstrate the superiority of a combination of photodynamic therapy (PDT) and anti-VEGF over PDT or anti-VEGF monotherapy for inducing polyp regression in Asian patients with PCV. The efficacy of other anti-VEGF agents has been less studied. Resistance to ranibizumab has been described. Aflibercept offers another mechanism of targeting choroidal neovascular lesions. A 75-year-old Caucasian woman presenting to our office was diagnosed with PCV using indocyanine green angiography. Combination therapy with a loading dose of 0.5 mg intravitreal ranibizumab followed by PDT at standard fluence at month 4 and a fourth dose of ranibizumab at month 5 yielded no visual or anatomic outcomes. Treatment was switched to intravitreal aflibercept at month 6 (3 monthly loading doses of 2.0 mg) followed by half-fluence PDT (month 9). Optical coherence tomography revealed remission of the anatomic lesions. Right-eye visual acuity increased to 0.6. Aflibercept injections were administered bimonthly afterwards. Follow-up during 1 year has shown functional and anatomic stability.
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Affiliation(s)
- Marta Medina-Baena
- Unidad de Retina y Vítreo, Hospital Universitario Puerto Real, Cádiz, Spain
| | | | - Laura Rodríguez
- Unidad de Retina y Vítreo, Hospital Universitario Puerta del Mar, Cádiz, Spain
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Chan EW, Eldeeb M, Lingam G, Thomas D, Bhargava M, Chee CK. Quantitative Changes in Pigment Epithelial Detachment Area and Volume Predict Retreatment in Polypoidal Choroidal Vasculopathy. Am J Ophthalmol 2017; 177:195-205. [PMID: 28007451 DOI: 10.1016/j.ajo.2016.12.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 12/08/2016] [Accepted: 12/10/2016] [Indexed: 11/24/2022]
Abstract
PURPOSE To determine if changes in pigment epithelial detachment (PED) area and volume predict retreatment in polypoidal choroidal vasculopathy (PCV). DESIGN Retrospective case-control study. METHODS PCV patients on pro re nata (PRN) anti-vascular endothelial growth factor (VEGF) therapy with >1 year follow-up at an academic retina service were included. Monthly anti-VEGF injections were given until a dry macula was achieved, and treatment deferred. Retreatment indication was recurrence of intraretinal or subretinal fluid or new hemorrhage. PED area and volume changes between visits with a dry macula ("D") and immediate preceding visits ("D-1") were analyzed with an automated optical coherence tomography-based software. Univariate and multivariate analyses were conducted to determine associations between changes in PED parameters and retreatment need at immediate subsequent visits ("D+1"). RESULTS Twenty-two PCV patients (mean age 69.6 years) were included. Of 46 visits D, 11 (23.9%) were followed by retreatment at D+1. An increase in PED area (>0.43 mm2) and volume (>0.0245 mm3) from D-1 to D was associated with 18.2 (95% CI, 3.7-125.6; P < .001) and 101.9 (95% CI, 9.5-14 308.0; P < .001) higher retreatment odds at D+1, respectively. These associations remained significant after multivariate analyses adjusting for baseline PED area or volume, greatest linear dimension, and type of anti-VEGF agent. CONCLUSION In PCV on PRN anti-VEGF therapy, increases in PED area and volume at one visit, despite achievement of a dry macula, are associated with retreatment at the next visit. Retreatment criteria relying on intraretinal or subretinal fluid or new hemorrhages may be expanded to include PED changes. Studies are needed to determine if using PED parameters in treatment decisions reduces recurrences.
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ANGIOGRAPHIC FINDINGS OF RANIBIZUMAB-RESISTANT POLYPOIDAL CHOROIDAL VASCULOPATHY AFTER SWITCHING TO A TREAT-AND-EXTEND REGIMEN WITH INTRAVITREAL AFLIBERCEPT. Retina 2017; 36:2158-2165. [PMID: 27258669 DOI: 10.1097/iae.0000000000001047] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to study the angiopathic findings of ranibizumab-resistant polypoidal choroidal vasculopathy after switching to a treat-and-extend regimen with intravitreal aflibercept. METHODS The authors retrospectively reviewed 17 eyes of 17 Japanese patients with polypoidal choroidal vasculopathy (10 men and 7 women, age: 73.8 ± 7.4 years) who were treated with intravitreal aflibercept (2 mg/0.05 mL) injections from February 2013 to August 2014 at Tokyo University Hospital. All patients had switched to aflibercept because their polypoidal choroidal vasculopathy had been refractory to ranibizumab. RESULTS The mean logMAR best-corrected visual acuity at baseline and after 12 months of therapy was 0.30 ± 0.29 (Snellen equivalent: 20/40) and 0.17 ± 0.26 (20/30) (paired t-test P < 0.001). Visual acuity remained stable in 5 cases (29%), deteriorated in 3 (18%), and improved in 9 (53%). Branching vascular networks persisted in all 17 eyes but shrank in 15 (88%). The mean lesion diameter was 3329 ± 1261 μm at baseline and 3180 ± 1247 μm after 12 months (P = 0.0002). CONCLUSION A treat-and-extend regimen with intravitreal aflibercept for ranibizumab-resistant patients resulted in branching vascular network shrinkage over a 1-year period.
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Kim JH, Chang YS, Lee DW, Kim CG, Kim JW. Incidence and Timing of the First Recurrence in Neovascular Age-Related Macular Degeneration: Comparison Between Ranibizumab and Aflibercept. J Ocul Pharmacol Ther 2017; 33:445-451. [PMID: 28384009 DOI: 10.1089/jop.2016.0098] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To compare the incidence and timing of first recurrence between patients who were treated with ranibizumab and aflibercept in neovascular age-related macular degeneration (AMD). METHODS This retrospective study included 120 patients who received the diagnosis of treatment-naive typical neovascular AMD or polypoidal choroidal vasculopathy (PCV) and were treated using either ranibizumab (n = 73) or aflibercept (n = 47). Recurrence within 10 months of the third injection was compared between the 2 treatment groups. RESULTS In all 120 patients, there was no difference in recurrence between the ranibizumab and the aflibecept groups (P = 0.846). One hundred five patients completed 12 months follow-up. In typical neovascular AMD, disease recurred in 69.6% (16/23) of patients in the ranibizumab group, with a mean period of 4.4 ± 1.8 months after the third injection. In the aflibercept group, the equivalent values were 68.8% (11/16) and 4.5 ± 1.4 months. In PCV, disease recurred in 72.5% (29/40) of patients in the ranibizumab group, with a mean period of 3.8 ± 1.7 months after the third injection. In the aflibercept group, the equivalent values were 69.2% (18/26) and 4.3 ± 2.0 months. CONCLUSIONS Although the incidence of recurrence was slightly higher and the duration between the third injection and the first recurrence was slightly shorter in patients treated using ranibizumab, the differences were not significant. Our results require confirmation in further studies.
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Affiliation(s)
- Jae Hui Kim
- 1 Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine , Seoul, South Korea
| | - Young Suk Chang
- 2 Department of Ophthalmology, Konyang University College of Medicine , Daejeon, South Korea
| | - Dong Won Lee
- 1 Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine , Seoul, South Korea
| | - Chul Gu Kim
- 1 Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine , Seoul, South Korea
| | - Jong Woo Kim
- 1 Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine , Seoul, South Korea
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Kim IG, Kim YI, Kim JS, Lee JH, Lee KW, Kang HG. Comparison of Choroidal Thickness Change between Ranibizumab and Aflibercept in Age-related Macular Degeneration: Six Month Results. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2017. [DOI: 10.3341/jkos.2017.58.3.296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Treatment of polypoidal choroidal vasculopathy by photodynamic therapy, aflibercept and dexamethasone triple therapy. Sci Rep 2016; 6:36870. [PMID: 27848983 PMCID: PMC5111116 DOI: 10.1038/srep36870] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 10/21/2016] [Indexed: 12/27/2022] Open
Abstract
Polypoidal choroidal vasculopathy is a relatively common type of degenerative macular disease among the Chinese population. This study aims to describe the therapeutic responses to combination therapy with photodynamic therapy, intravitreal aflibercept and intravitreal dexamethasone in patients with polypoidal choroidal vasculopathy. A prospective series of 17 eyes of 13 patients suffering from treatment-naïve polypoidal choroidal vasculoapathy were recruited. All cases received triple therapy with photodynamic therapy, intravitreal aflibercept and intravitreal dexamethasone and one year outcomes were reported. The baseline visual acuity was 0.65logMAR +/- 0.38 (Snellen 20/80 to 20/100). The visual acuity at 1 week, 3 months, 6 months and one year after treatment were significantly improved to 0.522logMAR+/- 0.365 (P < 0.04) (Snellen 20/70), 0.363logMAR+/-0.382 (Snellen 20/50;P < 0.001), 0.377logMAR +/- 0.440 (Snellen 20/50;p = 0.005), and 0.35logMAR +/- 0.407 (Snellen 20/40;P < 0.001), respectively. The baseline central foveal thickness (CFT) on optical coherence tomography (OCT) was 394.7 +/- 70.6 μm. CFT at 6 months and 1 year after treatment were significantly reduced to 259 +/- 54 μm (p = 0.004) and 271 +/- 49.7 μm(p = 0.016), respectively. Triple therapy with photodynamic therapy, intravitreal aflibercept and intravitreal dexamethasone is an effective treatment for polypoidal choroidal vasculopathy. The majority of cases responded well with significant responses observed as early as 1 week after initiation of therapy.
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Shin KH, Lee TG, Kim JH, Kim JW, Kim CG, Lee DW, Han JI, Lew YJ, Cho HJ. The Efficacy of Intravitreal Aflibercept in Submacular Hemorrhage Secondary to Wet Age-related Macular Degeneration. KOREAN JOURNAL OF OPHTHALMOLOGY 2016; 30:369-376. [PMID: 27729757 PMCID: PMC5057013 DOI: 10.3341/kjo.2016.30.5.369] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 12/01/2015] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate the efficacy of intravitreal aflibercept monotherapy in submacular hemorrhage (SMH) secondary to wet age-related macular degeneration (AMD). Methods This study included 25 eyes in 25 patients with SMH involving the fovea secondary to wet-AMD. All patients were treated with three consecutive monthly intravitreal aflibercept (2.0 mg/0.05 mL) injections, followed by as-needed reinjection. They were followed for at least 6 months. Best-corrected visual acuity (BCVA), central foveal thickness (CFT), and area of SMH were measured at diagnosis, as well as at 3 and 6 months after treatment initiation. Results The BCVA significantly improved from 0.79 ± 0.41 logarithm of the minimum angle of resolution (logMAR) at baseline to 0.54 ± 0.41 logMAR at 6 months (p < 0.001). BCVA ≥3 lines and stable vision were observed in 96% of the eyes. The CFT significantly decreased from 560.8 ± 215.3 µm at baseline to 299.8 ± 160.2 µm at 6 months (p < 0.001). The area of SMH significantly decreased from 10.5 ± 7.1 mm2 at baseline to 1.8 ± 6.5 mm2 at 6 months (p < 0.001). The BCVA, CFT, and area of SMH at baseline, as well as duration of symptoms, all correlated with BCVA at the 6-month follow-up. Conclusions Intravitreal injection of aflibercept is an effective treatment option for patients with SMH secondary to wet-AMD; however, there may be limited efficacy in eyes with large SMH area and cases in which treatment is delayed.
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Affiliation(s)
- Kyung-Hoon Shin
- Department of Ophthalmology, Kim's Eye Hospital, Myung-Gok Eye Research Institute, Konyang University College of Medicine, Seoul, Korea
| | - Tae Gon Lee
- Department of Ophthalmology, Kim's Eye Hospital, Myung-Gok Eye Research Institute, Konyang University College of Medicine, Seoul, Korea
| | - Jae Hui Kim
- Department of Ophthalmology, Kim's Eye Hospital, Myung-Gok Eye Research Institute, Konyang University College of Medicine, Seoul, Korea
| | - Jong Woo Kim
- Department of Ophthalmology, Kim's Eye Hospital, Myung-Gok Eye Research Institute, Konyang University College of Medicine, Seoul, Korea
| | - Chul Gu Kim
- Department of Ophthalmology, Kim's Eye Hospital, Myung-Gok Eye Research Institute, Konyang University College of Medicine, Seoul, Korea
| | - Dong Won Lee
- Department of Ophthalmology, Kim's Eye Hospital, Myung-Gok Eye Research Institute, Konyang University College of Medicine, Seoul, Korea
| | - Jung Il Han
- Department of Ophthalmology, Kim's Eye Hospital, Myung-Gok Eye Research Institute, Konyang University College of Medicine, Seoul, Korea
| | - Young Ju Lew
- Department of Ophthalmology, Kim's Eye Hospital, Myung-Gok Eye Research Institute, Konyang University College of Medicine, Seoul, Korea
| | - Han Joo Cho
- Department of Ophthalmology, Kim's Eye Hospital, Myung-Gok Eye Research Institute, Konyang University College of Medicine, Seoul, Korea
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Efficacy of intravitreal aflibercept in Japanese patients with exudative age-related macular degeneration. Jpn J Ophthalmol 2016; 61:74-83. [PMID: 27660164 DOI: 10.1007/s10384-016-0478-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Accepted: 09/01/2016] [Indexed: 10/21/2022]
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Lee JE, Shin JP, Kim HW, Chang W, Kim YC, Lee SJ, Chung IY, Lee JE. Efficacy of fixed-dosing aflibercept for treating polypoidal choroidal vasculopathy: 1-year results of the VAULT study. Graefes Arch Clin Exp Ophthalmol 2016; 255:493-502. [PMID: 27628062 PMCID: PMC5323470 DOI: 10.1007/s00417-016-3489-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 08/18/2016] [Accepted: 08/25/2016] [Indexed: 12/27/2022] Open
Abstract
Purpose To investigate fixed-dosing aflibercept for treating polypoidal choroidal vasculopathy (PCV). Methods This phase IV, prospective, single-arm, interventional case series was conducted in eight centers. Forty treatment-naïve PCV patients were administered three monthly doses of intravitreal aflibercept (2.0 mg) and an injection every 2 months thereafter. Best-corrected visual acuity (BCVA) and central subfield macular thickness (CSMT) were measured at each visit. Fluorescein and indocyanine green angiography (ICGA) were performed at baseline, 3 and 12 months. The primary outcome measure was the proportion of patients who maintained BCVA (<15 letters loss) at 12 months. Changes in BCVA, macular appearance, and polypoidal lesion appearance were also examined. Results Thirty-five eyes (87.5 %) had maintained BCVA at 12 months. Average BCVA was significantly higher at 12 months (20/53, 64.2 letters) than at baseline (20/80, 55.1 letters, 9-letter gain; P < .001). Mean CSMT was significantly lower at 12 months (253.6 μm) than at baseline (365.2 μm, P < .001). The macula was dry in 32 (76.2 %), 27 (64.3 %), and 24 eyes (60.0 %) at 3, 6, and 12 months respectively. Fourteen eyes (33.3 %) had a fluid recurrence or increase at 6 months, and they had a significantly lower vision gain (P = .005) than other patients at 12 months. Complete polyp regression occurred in 26 eyes (66.7 %) at 12 months. Conclusions Fixed-dosing aflibercept showed favorable outcomes in PCV patients at 12 months. However, some patients had worse outcomes because of fluid recurrence during maintenance dosing, and these patients would require additional treatments.
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Affiliation(s)
- Joo Eun Lee
- Department of Ophthalmology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Jae Pil Shin
- Department of Ophthalmology, Kyungpook National University Hospital, Deagu, South Korea
| | - Hyun Woong Kim
- Department of Ophthalmology, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Woohyok Chang
- Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, South Korea.,Chang's Retina Center, Daegu, South Korea
| | - Yu Cheol Kim
- Department of Ophthalmology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, South Korea
| | - Sang Joon Lee
- Department of Ophthalmology, College of Medicine and Institute of Medicine, Kosin University, Busan, South Korea
| | - In Young Chung
- Department of Ophthalmology, Gyeongsang National University School of Medicine, Jinju, South Korea
| | - Ji Eun Lee
- Department of Ophthalmology, Pusan National University Hospital, #179 Gudeok-ro, Seo-gu, Busan, 602-739, South Korea. .,Department of Ophthalmology, College of Medicine, Pusan National University, Yangsan, South Korea. .,Biomedical Research Institute, Pusan National University Hospital, #179 Gudeok-ro, Seo-gu, Busan, 602-739, South Korea.
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Jeong S, Sagong M. Short-term efficacy of intravitreal aflibercept depending on angiographic classification of polypoidal choroidal vasculopathy. Br J Ophthalmol 2016; 101:758-763. [PMID: 27597740 DOI: 10.1136/bjophthalmol-2016-309144] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 08/08/2016] [Accepted: 08/14/2016] [Indexed: 01/16/2023]
Abstract
BACKGROUND/AIMS To compare the short-term efficacy of intravitreal aflibercept treatment according to the subtypes of polypoidal choroidal vasculopathy (PCV) based on indocyanine green angiography (ICGA). METHODS Twenty-nine patients (29 eyes) with treatment-naïve subfoveal PCV were consecutively enrolled in this institutional study. The subjects were classified into two subtypes (type 1, polypoidal choroidal neovascularisation (CNV), 16 eyes; and type 2, idiopathic PCV, 13 eyes) based on the presence or absence of both feeder and draining vessels on ICGA. Intravitreal aflibercept was administered at baseline and at 1, 2 and 4 months. The primary outcome was the polyp regression percentage after 3 monthly injections. Changes in the best-corrected visual acuity and subfoveal choroidal thickness (CT) were evaluated at 3 and 6 months. RESULTS The complete polyp regression percentage was higher in type 1 than type 2 patients after 3 monthly injections (81% vs 30%, p=0.008). Type 1 patients showed better visual improvement at 3 months (-0.34 vs -0.08 logarithm of the minimum angle of resolution (logMAR), p=0.050) and 6 months (-0.30 vs -0.10 logMAR, p=0.168) than type 2 patients. Although subfoveal CT was significantly decreased after injections in both groups, type 2 patients with a thicker choroid at baseline showed a greater decrease than type 1 patients (p=0.032). CONCLUSIONS There was a difference in early treatment response with aflibercept between two subtypes of PCV. Type 1 polypoidal CNV showed better visual improvement with a higher percentage of polyp regression than type 2 idiopathic PCV. TRIAL REGISTRATION NUMBER NCT02597855, Results.
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Affiliation(s)
- Seongyong Jeong
- Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea
| | - Min Sagong
- Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea
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Abstract
PURPOSE To evaluate the 1-year results of intravitreal aflibercept injections for polypoidal choroidal vasculopathy based on indocyanine green angiography findings. METHODS Twenty-nine eyes with treatment-naive polypoidal choroidal vasculopathy treated with intravitreal aflibercept injections and followed longer than 1 year were retrospectively reviewed. The best-corrected visual acuity, optical coherence tomography findings, and polypoidal lesions in indocyanine green angiography were evaluated. RESULTS The mean number of injections through 1 year was 3.9 ± 1.9 (range: 1-8). Fourteen eyes (48%) were received no additional injections because of no recurrence of exudative change after the first loading dose. The mean best-corrected visual acuity levels at 6 months and 1 year significantly improved, and the mean central retinal thickness significantly decreased at all observation points from the baseline. At 3 months, the polypoidal lesions completely resolved in 19 (66%) eyes. At 1 year, the complete resolution of polypoidal lesions was seen in 4 of 10 eyes with persistent polypoidal lesions at 3 months. However, polypoidal lesions recurred at 1 year in 5 of 19 eyes (26%) with complete resolution of polypoidal lesions at 3 months. CONCLUSION Aflibercept is effective for the eyes with treatment-naive polypoidal choroidal vasculopathy to achieve the resolution of polypoidal lesions. The authors need to carefully observe the eyes after confirming complete resolution of polypoidal lesion because of recurrent polyps seen in one-quarter of the study eyes.
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Udaondo P, Salom D, García-Delpech S, Cisneros-Lanuza Á. Aflibercept as First-Line Therapy in Patients with Treatment-Naïve Neovascular Age-Related Macular Degeneration: Prospective Case Series Analysis in Real-Life Clinical Practice. Ophthalmologica 2016; 236:29-35. [PMID: 27348231 DOI: 10.1159/000445724] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 03/10/2016] [Indexed: 11/19/2022]
Abstract
PURPOSE To assess the 13-month effectiveness and safety of aflibercept in naïve patients with neovascular age-related macular degeneration (nvAMD) in a real-life clinical setting. METHODS Thirty-two treatment-naïve patients with nvAMD participated in a prospective two-center study. Patients received intravitreal injections of aflibercept (Eylea®), a loading dose of three monthly injections (2 mg/0.05 ml) every 4 weeks for the first 3 months, followed by intravitreal injections every 2 months. RESULTS At 3 and 13 months, the mean best-corrected visual acuity improved significantly as compared with baseline (logMAR 0.53 ± 0.30 and 0.55 ± 0.32 vs. 0.30 ± 0.24, respectively, p < 0.001). At 3 and 13 months, 46.8% of patients (15/32) gained ≥15 ETDRS letters. The mean decrease in central macular thickness was also significant at 3 months (252 ± 35 µm) and at 13 months (249 ± 38 µm) as compared with pretreatment values (383 ± 76 µm) (p < 0.01). Also, 50% resolution of pigment epithelial detachment (PED) was observed in 8 out of 9 eyes (88.9%) with PED at baseline. Intravitreal injections were well tolerated and no adverse events were recorded. CONCLUSION Aflibercept was effective and safe for treating nvAMD in naïve patients in routine daily practice.
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Affiliation(s)
- Patricia Udaondo
- Department of Ophthalmology, Hospital Universitari i Politx00E8;cnic La Fe de Valencia, Valencia, Spain
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Haslam B, Perez-Breva L. Learning disease relationships from clinical drug trials. J Am Med Inform Assoc 2016; 24:13-23. [PMID: 27189012 DOI: 10.1093/jamia/ocw003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 12/23/2015] [Accepted: 01/03/2016] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Our objective is to test the limits of the assumption that better learning from data in medicine requires more granular data. We hypothesize that clinical trial metadata contains latent scientific, clinical, and regulatory expert knowledge that can be accessed to draw conclusions about the underlying biology of diseases. We seek to demonstrate that this latent information can be uncovered from the whole body of clinical trials. MATERIALS AND METHODS We extract free-text metadata from 93 654 clinical drug trials and introduce a representation that allows us to compare different trials. We then construct a network of diseases using only the trial metadata. We view each trial as the summation of expert knowledge of biological mechanisms and medical evidence linking a disease to a drug believed to modulate the pathways of that disease. Our network representation allows us to visualize disease relationships based on this underlying information. RESULTS Our disease network shows surprising agreement with another disease network based on genetic data and on the Medical Subject Headings (MeSH) taxonomy, yet also contains unique disease similarities. DISCUSSION AND CONCLUSION The agreement of our results with other sources indicates that our premise regarding latent expert knowledge holds. The disease relationships unique to our network may be used to generate hypotheses for future biological and clinical research as well as drug repurposing and design. Our results provide an example of using experimental data on humans to generate biologically useful information and point to a set of new and promising strategies to link clinical outcomes data back to biological research.
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Affiliation(s)
- Bryan Haslam
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Luis Perez-Breva
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
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Kim JH, Lee TG, Chang YS, Kim CG, Cho SW. Short-term choroidal thickness changes in patients treated with either ranibizumab or aflibercept: a comparative study. Br J Ophthalmol 2016; 100:1634-1639. [PMID: 26951770 DOI: 10.1136/bjophthalmol-2015-308074] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 01/07/2016] [Accepted: 02/10/2016] [Indexed: 11/04/2022]
Abstract
PURPOSE To compare, in neovascular age-related macular degeneration (AMD) patients, short-term choroidal thickness changes in eyes treated using ranibizumab with those in eyes treated using aflibercept. METHODS This retrospective, observational study included 240 eyes from 240 patients who had been diagnosed with treatment-naive neovascular AMD and treated using three monthly injections of either ranibizumab (ranibizumab group) or aflibercept (aflibercept group). The choroidal thickness change between the time of diagnosis and 3 months later was compared between the two groups. Eyes were then classified into three disease groups: typical neovascular AMD, polypoidal choroidal vasculopathy (PCV) and retinal angiomatous proliferation (RAP). Within each disease group, choroidal thickness change was again compared between the two treatment groups. RESULTS In the ranibizumab group (n=155), the mean choroidal thicknesses at diagnosis and at 3 months were 255.3±103.9 μm and 242.9±104.8 μm, respectively. In the aflibercept group (n=85), the values were 277.5±119.1 μm and 254.7±114.5 μm, respectively. The decrease was significantly greater in the aflibercept group (p<0.001). In the PCV group, the decrease was greater in the aflibercept group (p=0.001), whereas the difference was not significant in either the typical neovascular AMD group or the RAP group. CONCLUSIONS A greater decrease in choroidal thickness was noted in eyes treated with aflibercept than in eyes treated with ranibizumab. This difference was more marked in PCV than in other subtypes of neovascular AMD.
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Affiliation(s)
- Jae Hui Kim
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, South Korea
| | - Tae Gon Lee
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, South Korea
| | - Young Suk Chang
- Department of Ophthalmology, Konyang University College of Medicine, Daejeon, South Korea
| | - Chul Gu Kim
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, South Korea
| | - Sung Won Cho
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, South Korea
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Sudhalkar A, Balakrishnan D, Jalali S, Narayanan R. Systemic steroids as an aid to the management of Idiopathic Polypoidal Choroidal Vasculopathy (IPCV): A descriptive analysis. Saudi J Ophthalmol 2016; 30:14-9. [PMID: 26949352 PMCID: PMC4759500 DOI: 10.1016/j.sjopt.2015.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 02/13/2015] [Accepted: 08/04/2015] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To determine the role of systemic steroids in improving visual acuity, preventing recurrence and hastening pigment epithelial detachment resolution in IPCV patients. METHODS Retrospective computer assisted comparative case series of consecutive patients with documented IPCV who did and did not receive systemic steroids as part of their treatment regimen between 2007 and 2012. Patients who had systemic contraindication to steroid therapy were excluded from the steroid arm. Data collected included demographics, the best corrected visual acuity, details of the ocular and systemic exam, the treatment offered, the follow-up period and the final visual and anatomic outcomes. Outcome measures included the final BCVA, the time to resolution of the associated pigment epithelial detachment (PED, if present), the recurrence rate and the associated side effects, if any. Appropriate statistical analysis was done. Statistical significance: p < 0.05. RESULTS 14 patients (14 eyes) had received systemic steroids in the stated period; these were compared with 26 consecutive patients (26 eyes) who did not. Mean age: 59.24 vs 62.38 years (A vs B). Mean baseline BCVA: 1.86 ± 1.24 logMAR vs 2.12 ± 1.48 logMAR (A vs B). 8 females in Group A and 14 in Group B. 11 patients in group A and 19 in group B had associated systemic hypertension. Therapy consisted of laser photocoagulation, anti-vascular endothelial growth factor therapy, photodynamic therapy or a combination of these. Mean follow-up: 43.21 ± 11.32 months (Group A) vs 48.24 ± 9.75 months (Group B). BCVA at three months was significantly better (0.84 ± 0.74 logMAR vs 1.16 ± 0.89 (p = 0.039). Final BCVA: 0.86 ± 0.78 logMAR (Group A) vs 1.29 ± 0.92 (Group B, p = 0.042). 7 patients in group A and 12 in Group B had a recurrence (insignificant difference). 1 patient in Group A and 7 in Group B had unresolved disease (persistent PED) at the end of follow-up (OR: 4.60; 95% CI 1.7-11.10). CONCLUSION Steroids appear to improve visual acuity and accelerate the resolution of the PEDs in patients with IPCV and large PEDs, but do not seem to influence recurrence.
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Affiliation(s)
| | - Divya Balakrishnan
- Smt. Kanuri Santhamma Centre For Vitreoretinal Diseases, LV Prasad Eye Institute, Hyderabad, India
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Lee D, Jeong S, Moon J, Lee J, Sagong M. Analysis of Efficacy of Intravitreal Aflibercept According to Subfoveal Choroidal Thickness in Polypoidal Choroidal Vasculopathy. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2016. [DOI: 10.3341/jkos.2016.57.10.1577] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Donghun Lee
- Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea
| | - Seongyong Jeong
- Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea
| | - Jongwon Moon
- Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea
| | - Junyeop Lee
- Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea
| | - Min Sagong
- Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea
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García-Layana A, Figueroa MS, Araiz J, Ruiz-Moreno JM, Gómez-Ulla F, Arias-Barquet L, Reiter N. Treatment of Exudative Age-related Macular Degeneration: Focus on Aflibercept. Drugs Aging 2015; 32:797-807. [PMID: 26442858 PMCID: PMC4607716 DOI: 10.1007/s40266-015-0300-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A formulation of aflibercept for intravitreal injection (Eylea) is approved for the treatment of patients with exudative age-related macular degeneration (AMD). Aflibercept has a significantly higher affinity for Vascular endothelial growth factor (VEGF)-A compared with other monoclonal anti-VEGF antibodies. In addition to binding all VEGF-A isoforms, aflibercept also blocks other proangiogenic factors such as VEGF-B and placental growth factor. The VIEW 1 and 2 trials showed this drug achieves improved results in patients with exudative AMD similar to those obtained with monthly ranibizumab, using a bimonthly treatment regimen after a loading dose of three intravitreal injections, which translates to less use of healthcare resources. There is a subgroup of patients that present with persistent fluid after the loading dose that could benefit from monthly injections or personalized proactive treatment after the first year. In the second year of treatment, the Treat and Extend patterns can permit even more lengthening of the time between injections. More data are needed to confirm the optimal monitoring and retreatment dosing, to maintain long-term efficacy. Other preliminary data suggest that patients that do not respond to other anti-angiogenics and patients with special pathologies such as polypoidal choroidopathy or retinal angiomatous proliferation can improve upon switching to aflibercept. To date, the safety profile of aflibercept is excellent and is comparable to other anti-angiogenic treatments.
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MESH Headings
- Aged
- Aged, 80 and over
- Aging/pathology
- Angiogenesis Inhibitors/administration & dosage
- Angiogenesis Inhibitors/adverse effects
- Angiogenesis Inhibitors/therapeutic use
- Antibodies, Monoclonal, Humanized/administration & dosage
- Antibodies, Monoclonal, Humanized/adverse effects
- Antibodies, Monoclonal, Humanized/therapeutic use
- Clinical Trials as Topic
- Drug Administration Schedule
- Female
- Humans
- Intravitreal Injections
- Male
- Middle Aged
- Ranibizumab/administration & dosage
- Ranibizumab/adverse effects
- Ranibizumab/therapeutic use
- Receptors, Vascular Endothelial Growth Factor/administration & dosage
- Receptors, Vascular Endothelial Growth Factor/adverse effects
- Receptors, Vascular Endothelial Growth Factor/therapeutic use
- Recombinant Fusion Proteins/administration & dosage
- Recombinant Fusion Proteins/adverse effects
- Recombinant Fusion Proteins/therapeutic use
- Treatment Outcome
- Vascular Endothelial Growth Factor A/metabolism
- Wet Macular Degeneration/drug therapy
- Wet Macular Degeneration/metabolism
- Wet Macular Degeneration/pathology
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Affiliation(s)
- Alfredo García-Layana
- Department of Ophthalmology, Clinica Universidad de Navarra, Pio XII 36, 31080, Pamplona, Navarra, Spain.
- Sociedad Española de Retina y Vítreo (SERV), Red Temática de Investigación Cooperativa Oftared, Instituto de Salud Carlos III, Madrid, Spain.
| | - Marta S Figueroa
- Sociedad Española de Retina y Vítreo (SERV), Red Temática de Investigación Cooperativa Oftared, Instituto de Salud Carlos III, Madrid, Spain
- Vissum Madrid, Department of Retina and Vitreous, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Javier Araiz
- Sociedad Española de Retina y Vítreo (SERV), Red Temática de Investigación Cooperativa Oftared, Instituto de Salud Carlos III, Madrid, Spain
- Ophthalmology Service, Hospital San Eloy, Barakaldo, Bizcaia, Spain
| | - José M Ruiz-Moreno
- Sociedad Española de Retina y Vítreo (SERV), Red Temática de Investigación Cooperativa Oftared, Instituto de Salud Carlos III, Madrid, Spain
- Instituto Europeo de la Retina, Clínica Baviera, Universidad de Castilla La Mancha, Albacete, Spain
| | - Francisco Gómez-Ulla
- Sociedad Española de Retina y Vítreo (SERV), Red Temática de Investigación Cooperativa Oftared, Instituto de Salud Carlos III, Madrid, Spain
- Instituto Oftalmológico Gómez-Ulla, Santiago de Compostela, A Coruña, Spain
| | - Luis Arias-Barquet
- Sociedad Española de Retina y Vítreo (SERV), Red Temática de Investigación Cooperativa Oftared, Instituto de Salud Carlos III, Madrid, Spain
- Ophthalmology Service, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Nicholas Reiter
- Department of Ophthalmology, Clinica Universidad de Navarra, Pio XII 36, 31080, Pamplona, Navarra, Spain
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Yamamoto A, Okada AA, Kano M, Koizumi H, Saito M, Maruko I, Sekiryu T, Iida T. One-Year Results of Intravitreal Aflibercept for Polypoidal Choroidal Vasculopathy. Ophthalmology 2015; 122:1866-72. [PMID: 26088619 DOI: 10.1016/j.ophtha.2015.05.024] [Citation(s) in RCA: 108] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 05/14/2015] [Accepted: 05/15/2015] [Indexed: 12/27/2022] Open
Abstract
PURPOSE To investigate 1-year outcomes of intravitreal aflibercept for polypoidal choroidal vasculopathy (PCV). DESIGN Retrospective, multicenter, consecutive case series. PARTICIPANTS A total of 90 eyes of 87 patients with treatment-naïve PCV followed at 3 tertiary centers. METHODS Clinical records were reviewed and imaging studies were analyzed of eyes with PCV that underwent 3 consecutive monthly aflibercept injections followed by injections every 2 months. Additional (rescue) injections were performed for worsening. MAIN OUTCOME MEASURES Best-corrected visual acuity (BCVA), optical coherence tomography (OCT), and angiographic findings at 1 year. RESULTS The mean BCVA (logarithm of the minimum angle of resolution units) of the 90 eyes improved from 0.31 at baseline to 0.17 at 12 months (P < 0.001). The mean central retinal thickness decreased from 315 μm at baseline to 204 μm at 12 months (P < 0.001). At 12 months, 64 eyes (71.1%) achieved a dry macula, defined as absence of intraretinal or subretinal fluid on OCT. Of 83 eyes that underwent indocyanine green angiography at both baseline and 12 months, 46 (55.4%) showed complete and 27 (32.5%) showed partial resolution of polypoidal lesions. Eleven of 82 eyes (13.4%) showed decreased size of branching choroidal vascular networks. CONCLUSIONS Intravitreal aflibercept administered over 1 year improved both visual acuity and macular morphology in a large number of treatment-naïve eyes with PCV.
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Affiliation(s)
- Akiko Yamamoto
- Department of Ophthalmology at Kyorin University School of Medicine, Tokyo, Japan
| | - Annabelle A Okada
- Department of Ophthalmology at Kyorin University School of Medicine, Tokyo, Japan.
| | - Mariko Kano
- Department of Ophthalmology at Fukushima Medical University, Fukushima, Japan
| | - Hideki Koizumi
- Department of Ophthalmology, Tokyo Women's Medical University, Tokyo, Japan
| | - Masaaki Saito
- Department of Ophthalmology at Fukushima Medical University, Fukushima, Japan
| | - Ichiro Maruko
- Department of Ophthalmology, Tokyo Women's Medical University, Tokyo, Japan
| | - Tetsuju Sekiryu
- Department of Ophthalmology at Fukushima Medical University, Fukushima, Japan
| | - Tomohiro Iida
- Department of Ophthalmology, Tokyo Women's Medical University, Tokyo, Japan
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Wong CW, Wong TY, Cheung CMG. Polypoidal Choroidal Vasculopathy in Asians. J Clin Med 2015; 4:782-821. [PMID: 26239448 PMCID: PMC4470199 DOI: 10.3390/jcm4050782] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Accepted: 04/13/2015] [Indexed: 01/16/2023] Open
Abstract
Age related macular degeneration (AMD) in Asians has been suggested to differ from their Western counterparts in terms of epidemiology, pathogenesis, clinical presentation and treatment. In particular, polypoidal choroidal vasculopathy (PCV) appears to be the predominant subtype of exudative AMD in Asian populations, in contrast to choroidal neovascularization secondary to AMD (CNV-AMD) in Western populations. Epidemiological data on PCV has been largely limited to hospital-based studies and there are currently no data on the incidence of PCV. Similarities and differences in risk factor profile between PCV and CNV-AMD point to some shared pathogenic mechanisms but also differential underlying mechanisms leading to the development of each phenotype. Serum biomarkers such as CRP, homocysteine and matrix metalloproteinases suggest underlying inflammation, atherosclerosis and deranged extracellular matrix metabolism as possible pathogenic mechanisms. In addition, recent advances in genome sequencing have revealed differences in genetic determinants of each subtype. While the standard of care for CNV-AMD is anti-vascular endothelial growth factor (VEGF) therapy, photodynamic therapy (PDT) has been the mainstay of treatment for PCV, although long-term visual prognosis remains unsatisfactory. The optimal treatment for PCV requires further clarification, particularly with different types of anti-VEGF agents and possible benefits of reduced fluence PDT.
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Affiliation(s)
- Chee Wai Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, 11 Third Hospital Avenue, 168751 Singapore, Singapore.
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Graduate Medical School, National University of Singapore, 169857 Singapore, Singapore.
| | - Tien Y Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, 11 Third Hospital Avenue, 168751 Singapore, Singapore.
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Graduate Medical School, National University of Singapore, 169857 Singapore, Singapore.
| | - Chui Ming Gemmy Cheung
- Singapore Eye Research Institute, Singapore National Eye Centre, 11 Third Hospital Avenue, 168751 Singapore, Singapore.
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Graduate Medical School, National University of Singapore, 169857 Singapore, Singapore.
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Lu X, Sun X. Profile of conbercept in the treatment of neovascular age-related macular degeneration. DRUG DESIGN DEVELOPMENT AND THERAPY 2015; 9:2311-20. [PMID: 25960634 PMCID: PMC4410828 DOI: 10.2147/dddt.s67536] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
In developed countries, age-related macular degeneration (AMD) is the leading cause of irreversible blindness in individuals over the age of 65 years. Vascular endothelial growth factor (VEGF) plays a vital role in the formation of neovascular AMD. VEGF regulates angiogenesis, enhances vascular permeability, and drives the formation of choroidal neovascularization. As a result of the introduction of anti-VEGF drugs, the incidence of blindness from neovascular AMD has greatly reduced. Anti-VEGF drugs are used as a first-line treatment for neovascular AMD. The most recent anti-VEGF drug is conbercept, also named KH902, which was approved for the treatment of neovascular AMD by the China Food and Drug Administration in December 2013. In this review, recent clinical information regarding the use of conbercept to treat neovascular AMD is summarized. Conbercept is a soluble receptor decoy that blocks all isoforms of VEGF-A, VEGF-B, VEGF-C, and PlGF, which has a high binding affinity to VEGF and a long half-life in vitreous. Preclinical studies have demonstrated its anti-angiogenesis activity in both ocular neovascular disease models and tumor models. Clinical trials of conbercept have shown its superior efficacy and safety. Patients respond well even with 3-month treatment intervals following loading doses once a month for 3 months. The potential therapeutic effect of conbercept on the treatment of polypoidal choroidal vasculopathy, a special type of neovascular AMD, is also promising. In summary, conbercept is a new treatment option for ophthalmologists and their patients and may help address the limitations of current anti-VEGF drugs.
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Affiliation(s)
- Xinmin Lu
- Department of Ophthalmology, Shanghai First People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Xiaodong Sun
- Department of Ophthalmology, Shanghai First People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China ; Eye Research Institute of Shanghai Jiao Tong University, Shanghai, People's Republic of China ; Shanghai Key Laboratory of Fundus Disease, Shanghai, People's Republic of China
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Clinical characteristics and antivascular endothelial growth factor effect of choroidal neovascularization in younger patients in Taiwan. Taiwan J Ophthalmol 2015; 5:76-84. [PMID: 29018672 PMCID: PMC5602732 DOI: 10.1016/j.tjo.2015.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 02/05/2015] [Accepted: 03/01/2015] [Indexed: 11/21/2022] Open
Abstract
Background/Purpose: The purpose of this study is to share experiences diagnosing and treating choroidal neovascularization (CNV) in young patients (age ≤ 50 years) at our hospital. Methods: The study reviewed retrospective data of patients (≤ 50 years old) with CNV who received antivascular endothelial growth factor treatment (anti-VEGF) between January 2007 and August 2012 at Shin Kong Wu Ho-Su Memorial Hospital. We recorded the total number of injections, types of drugs, preoperative and final best-corrected visual acuity (BCVA), central retinal thickness (CRT) in optical coherence tomography (OCT), and total follow-up times, and then used two-tailed paired t tests to compare mean changes in BCVA and CRT on OCT. Results: The study enrolled 59 patients ≤ 50 years of age with CNV diagnosed in 67 eyes. The mean age was 36.9 ± 10.0 years (range, 8–50 years). Twenty-one patients were male and 38 patients were female. Forty-two CNV lesions were subfoveal, 19 were juxtafoveal, and five were extrafoveal. The mean total follow-up time was 18.5 ± 19.9 months (range, 0.5–71 months). Pathologic myopia was the most common cause of CNV in this study (47.8%), followed by punctate inner choroidopathy (17.9%), idiopathic CNV (16.4%), polypoidal choroidal vasculopathy (13.4%), angioid streaks (3.0%), and choroidal rupture (1.5%). After anti-VEGF treatment, the mean BCVA improved from 0.69 ± 0.61 to 0.42 ± 0.59 (p < 0.05). CRT decreased from 257.5 ± 48.2 to 210.3 ± 35.7 (p < 0.05). The mean number of injections was 1.9 ± 1.6 (range, 1–9). Conclusion: In this study we found that pathologic myopia, punctate inner choroidopathy, and idiopathic and polypoidal choroidal vasculopathy comprised the four most common causes of CNV in patients ≤ 50 years of age in Taiwan. We also revealed that anti-VEGF treatment is highly effective in the treatment of CNV in this age group.
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Koizumi H, Kano M, Yamamoto A, Saito M, Maruko I, Sekiryu T, Okada AA, Iida T. Aflibercept therapy for polypoidal choroidal vasculopathy: short-term results of a multicentre study. Br J Ophthalmol 2015; 99:1284-8. [PMID: 25777816 DOI: 10.1136/bjophthalmol-2014-306432] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 02/23/2015] [Indexed: 12/30/2022]
Affiliation(s)
- Hideki Koizumi
- Department of Ophthalmology, Tokyo Women's Medical University, Tokyo, Japan
| | - Mariko Kano
- Fukushima Medical University, Fukushima, Japan
| | | | | | - Ichiro Maruko
- Department of Ophthalmology, Tokyo Women's Medical University, Tokyo, Japan
| | | | | | - Tomohiro Iida
- Department of Ophthalmology, Tokyo Women's Medical University, Tokyo, Japan
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Yang H, Jeon HM, Kim SW, Yoon HS, Choae WS. Short-Term Efficacy of Intravitreal Aflibercept for Polypoidal Choroidal Vasculopathy. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2015. [DOI: 10.3341/jkos.2015.56.11.1728] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Hikichi T, Kitamei H, Shioya S. Prognostic factors of 2-year outcomes of ranibizumab therapy for polypoidal choroidal vasculopathy. Br J Ophthalmol 2014; 99:817-22. [PMID: 25480464 DOI: 10.1136/bjophthalmol-2014-305606] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 11/19/2014] [Indexed: 11/04/2022]
Abstract
PURPOSE To determine predictors of 2-year outcomes after three, monthly, intravitreal ranibizumab (IVR) injections followed by as-needed injections for treatment-naive polypoidal choroidal vasculopathy (PCV). METHODS This trial included 85 Japanese patients with symptomatic treatment-naive PCV who received one 0.5 mg IVR injection monthly for 3 months followed by as-needed retreatments. PCV with subfoveal leakage on fluorescein angiography with or without actual choroidal neovascularisation were included. Analyses evaluated independent baseline predictors of better and improved visual acuity (VA) and need for fewer reinjections 2 years after the first injection. RESULTS After the three monthly injections, 1.3±1.4 and 1.5±2.0 (mean±SD) as-needed injections were administered during years 1 and 2, respectively. The baseline logarithm of the minimum angle of resolution, VA (0.60±0.49) improved significantly (p=0.001) (0.41±0.47) 2 years after the first injection. Younger patients' eyes with a better baseline VA and no cluster of grape-like polypoidal lesions were significant independent predictors of better VA 2 years after treatment. No baseline factors predicted fewer ranibizumab reinjections during 2 years. At 2 years, resolution of polypoidal lesions 1 month after the three monthly injections did not affect VA and number of reinjections during 2 years. CONCLUSIONS Patient age, baseline VA and clusters of grape-like polypoidal lesions predicted VA outcomes 2 years after treatment with IVR for PCV.
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Affiliation(s)
- Taiichi Hikichi
- Department of Ophthalmology, Ohtsuka Eye Hospital, Sapporo, Japan
| | - Hirokuni Kitamei
- Department of Ophthalmology, Ohtsuka Eye Hospital, Sapporo, Japan
| | - Shoko Shioya
- Department of Ophthalmology, Ohtsuka Eye Hospital, Sapporo, Japan
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