Short-term efficacy of intravitreal Aflibercept injections for retinal angiomatous proliferation

Hung-Da Chou,Kuan-Jen Chen,Chi-Chun Lai,Wei-Chi Wu,Nan-Kai Wang,Lan-Hsin Chuang

doi:10.1186/s12886-017-0497-0

Abstract

BackgroundTo evaluate the short-term efficacy of intravitreal injections of aflibercept (IVA) to treat retinal angiomatous proliferation (RAP) and identify factors related to functional outcomes.MethodsThis retrospective case series consisted of 19 eyes in 19 patients with RAP. All 19 eyes received 3 monthly consecutive IVA. The primary outcome measures were best-corrected visual acuity (BCVA) and central retinal thickness (CRT) after the last IVA.ResultsOf the 19 treated eyes, 8 (42%) were pre-treated with 1 dose of bevacizumab one month prior to the initiation of treatment with aflibercept. BCVA was significantly improved and CRT was significantly reduced after 3 consecutive IVAs (P = 0.014 and P = 0.0002, respectively). Stabilization or improvement in BCVA was observed in 17 eyes (90%) treated with IVA. Eyes with baseline fibrovascular pigment epithelial detachment (PED) showed no significant gain in BCVA, and fibrovascular PED was negatively correlated with final BCVA (Spearman’s correlation coefficient = − 0.481, P = 0.037). The mean follow-up was 3.5 ± 0.5 months.ConclusionsIn this short-term study, three consecutive IVAs showed efficacy for improving vision and reducing retinal edema in RAP patients. Eyes with fibrovascular PED showed poorer responses, and the presence of fibrovascular PED at baseline was negatively correlated with visual outcomes.

Highlights

To evaluate the short-term efficacy of intravitreal injections of aflibercept (IVA) to treat retinal angiomatous proliferation (RAP) and identify factors related to functional outcomes
Retinal angiomatous proliferation (RAP) is recognized as a variant of neovascular age-related macular degeneration that displays a tendency to develop into a bilateral disease and has been associated with a guarded visual prognosis [1,2,3]
The diagnostic criteria for RAP lesions were based on clinical and angiographic findings [21], including 1) age of 55 years old or older; 2) neovascular age-related macular degeneration (nAMD) with characteristics of intraretinal lesions when observed on optical coherence tomography (OCT), including associated intraretinal edema with or without sub-retinal pigment epithelium (RPE) fluid; 3) focal hyperfluourescent lesions and late leakage on fluorescein angiography (FA) at the site of an intraretinal lesion; and 4) a corresponding “hot spot” on indocyanine green angiography (ICGA)

Summary

Introduction

To evaluate the short-term efficacy of intravitreal injections of aflibercept (IVA) to treat retinal angiomatous proliferation (RAP) and identify factors related to functional outcomes. Retinal angiomatous proliferation (RAP) is recognized as a variant of neovascular age-related macular degeneration (nAMD) that displays a tendency to develop into a bilateral disease and has been associated with a guarded visual prognosis [1,2,3]. Before the introduction of anti-vascular endothelial growth factor (anti-VEGF) agents, treatments for RAP included conventional laser photocoagulation [7], surgical. Intravitreal injections of anti-VEGF agents, such as bevacizumab (Avastin®, Genentech, South San Francisco, California, USA) and ranibizumab (Lucentis®; Genentech, South San Francisco, California, USA), have shown promising results for the treatment of RAP [14,15,16].

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