Response of Pigment Epithelial Detachment to Anti–Vascular Endothelial Growth Factor Treatment in Age-Related Macular Degeneration

Abstract

To evaluate the therapeutic response of pigment epithelial detachment (PED) to anti-vascular endothelial growth factor (VEGF) treatment in neovascular age-related macular degeneration (nAMD), and identify predictive factors for PED resolution after treatment. Retrospective, interventional case series. A total of 202 treatment-naïve nAMD eyes presenting PED at baseline were retrospectively included and analyzed. All patients were treated with an initial series of 3monthly loading injections of ranibizumab or aflibercept, followed by additional injections as required. After 12months of treatment, the mean PED height decreased from 453 ± 261μm at baseline to 230 ± 142μm (P= .002), and the mean best-corrected visual acuity improved from 0.71 ± 0.41 logarithm of the minimal angle of resolution (Snellen equivalent, 20/102) to 0.60 ± 0.36 (20/79) (P=.024). The proportion of complete PED resolution after treatment was 19.3% (39 eyes). Multivariate logistic regression analysis was used to find baseline characteristics associated with a higher chance of PED resolution, including lower PED height at baseline (P= .018), polypoidal choroidal vasculopathy (P= .015), or retinal angiomatous proliferation (P= .010) compared to typical nAMD; serous PED (P= .022) compared to fibrovascular PED; and aflibercept (P= .039) compared to ranibizumab. PEDs secondary to nAMD showed significant functional and anatomic improvement after intravitreal anti-VEGF injections over 12months. However, the anti-VEGF treatment showed limited efficacy for the complete resolution of PED. The PED type, nAMD subtype, baseline PED height, and anti-VEGF drug type was associated with a higher probability of PED resolution after treatment.